Healthcare Provider Details

I. General information

NPI: 1043488570
Provider Name (Legal Business Name): MICHELLE D WELLMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE D ROBLYER

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 W 12600 S STE 200
RIVERTON UT
84065-7215
US

IV. Provider business mailing address

572 S CROOKED POST WAY
SARATOGA SPRINGS UT
84045-5449
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-3400
  • Fax: 801-285-3401
Mailing address:
  • Phone: 509-851-3791
  • Fax: 801-285-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC00001051
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61194912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: