Healthcare Provider Details

I. General information

NPI: 1982167854
Provider Name (Legal Business Name): VANESSA ALLERUZZO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 W 1700 S STE B5
SYRACUSE UT
84075-7205
US

IV. Provider business mailing address

2052 W 1700 S STE B5
SYRACUSE UT
84075-7205
US

V. Phone/Fax

Practice location:
  • Phone: 385-393-7824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3551
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number404358
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: