Healthcare Provider Details

I. General information

NPI: 1396560033
Provider Name (Legal Business Name): PRIYA PATEL WILDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 400 N
OREM UT
84057
US

IV. Provider business mailing address

773 S 290 W
AMERICAN FORK UT
84003-4403
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3366
  • Fax:
Mailing address:
  • Phone: 205-657-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14186254-4201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number14186254-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: