Healthcare Provider Details

I. General information

NPI: 1831815026
Provider Name (Legal Business Name): ASHLEE JOHNSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 400 N STE 6
OREM UT
84057-1951
US

IV. Provider business mailing address

3552 W HONDA AVE
WEST VALLEY CITY UT
84119-1606
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3366
  • Fax: 801-714-3227
Mailing address:
  • Phone: 385-227-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number12874632-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: