Healthcare Provider Details

I. General information

NPI: 1376457523
Provider Name (Legal Business Name): EMILY BIVINS MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY BEAUMONT

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

932 S 900 E
SALT LAKE CITY UT
84105-1320
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 504-444-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1413886-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: