Healthcare Provider Details

I. General information

NPI: 1346843315
Provider Name (Legal Business Name): NATHAN LEE POPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S 140 E
SALEM UT
84653-2077
US

IV. Provider business mailing address

934 S 140 E
SALEM UT
84653-2077
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-2783
  • Fax:
Mailing address:
  • Phone: 801-310-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number369546-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: