Healthcare Provider Details

I. General information

NPI: 1043541600
Provider Name (Legal Business Name): JESSICA LEVY PPOTD, MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S DEEP CREEK DR
WASHINGTON UT
84780-3672
US

IV. Provider business mailing address

331 S DEEP CREEK DR
WASHINGTON UT
84780-3672
US

V. Phone/Fax

Practice location:
  • Phone: 435-393-7456
  • Fax: 385-218-3494
Mailing address:
  • Phone: 435-393-7456
  • Fax: 385-218-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010319
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC010319
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: