Healthcare Provider Details

I. General information

NPI: 1346178886
Provider Name (Legal Business Name): ERICA ELLYN EMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E COATSVILLE AVE
SALT LAKE CITY UT
84115-3673
US

IV. Provider business mailing address

8171 N IRON HORSE DR
LAKE POINT UT
84074-3496
US

V. Phone/Fax

Practice location:
  • Phone: 920-933-9142
  • Fax:
Mailing address:
  • Phone: 920-933-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number11940168-4001
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: