Healthcare Provider Details

I. General information

NPI: 1073663902
Provider Name (Legal Business Name): MISS LINDEY DAWN WORKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SLC UT
84132-0001
US

IV. Provider business mailing address

36 QUAYLE AVE
SALT LAKE CITY UT
84115-1941
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2733
  • Fax:
Mailing address:
  • Phone: 801-725-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number361730-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: