Healthcare Provider Details

I. General information

NPI: 1972863546
Provider Name (Legal Business Name): CATHERINE STONEBRAKER MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ALPINE AVE
PLEASANT GROVE UT
84062-3511
US

IV. Provider business mailing address

936 W 1290 N
PLEASANT GROVE UT
84062-9214
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-3568
  • Fax:
Mailing address:
  • Phone: 801-560-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7905154-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: