Healthcare Provider Details

I. General information

NPI: 1972468684
Provider Name (Legal Business Name): AMELIA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ALPINE DR
PLEASANT GROVE UT
84062-3511
US

IV. Provider business mailing address

118 N 850 E
SALEM UT
84653-5684
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-3568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number142610434003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: