=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245154806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYNNE LARSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 E 2700 S
-----------------------------------------------------
City | SOUTH SALT LAKE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84115-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-487-2248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2268 W HARKER FARM LN
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84129-5412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-389-6838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225800000X
-----------------------------------------------------
Taxonomy Name | Recreation Therapist
-----------------------------------------------------
License Number | 88905
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------