Healthcare Provider Details

I. General information

NPI: 1477462125
Provider Name (Legal Business Name): PETER DOUGLAS HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 S CONNOR ST
SALT LAKE CITY UT
84109-1932
US

IV. Provider business mailing address

2870 S CONNOR ST
SALT LAKE CITY UT
84109-1932
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-4848
  • Fax:
Mailing address:
  • Phone: 801-281-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number142964654201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: