Healthcare Provider Details

I. General information

NPI: 1053330597
Provider Name (Legal Business Name): THERESA J WOODEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2762 N 1375 E
NORTH OGDEN UT
84414-3419
US

IV. Provider business mailing address

2762 N 1375 E
NORTH OGDEN UT
84414-3419
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-5935
  • Fax: 801-782-5136
Mailing address:
  • Phone: 801-782-5935
  • Fax: 801-782-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number378913-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: