Healthcare Provider Details

I. General information

NPI: 1033840681
Provider Name (Legal Business Name): ANDREW KALT NIELSEN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W TABERNACLE ST
ST GEORGE UT
84770-3338
US

IV. Provider business mailing address

3960 BELLA VISTA DR
SANTA CLARA UT
84765-5684
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-3553
  • Fax:
Mailing address:
  • Phone: 801-900-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11565326-4201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11565326-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: