Healthcare Provider Details

I. General information

NPI: 1437476348
Provider Name (Legal Business Name): RHONDA DAMERON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 05/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 REDSTONE CENTER DR SUITE 200
PARK CITY UT
84098-7605
US

IV. Provider business mailing address

PO BOX 210252
NASHVILLE TN
37221-0252
US

V. Phone/Fax

Practice location:
  • Phone: 866-474-6677
  • Fax: 435-645-0792
Mailing address:
  • Phone: 615-730-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0000003758
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: