Healthcare Provider Details

I. General information

NPI: 1073425906
Provider Name (Legal Business Name): CAROL MELIZA SPILLARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E 5350 S
OGDEN UT
84405-6934
US

IV. Provider business mailing address

1071 N 5000 W
WEST POINT UT
84015-7036
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-6700
  • Fax:
Mailing address:
  • Phone: 385-294-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14310233-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: