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General NPI Number Information
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NPI Number | 1568859684
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Entity Type | Individual
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Provider Name | BONNIE LYN GIVEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 2500 S STATE ST
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-3164
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Country | US
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Telephone | 801-989-8679
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Fax |
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Provider Business Mailing Address
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Address Line | 7673 S SUMMIT PEAK DR D208
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City | SALT LAKE CITY
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State | UT
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Zip | 84046
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Country | US
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Telephone | 801-989-8679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 9363203-4201
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License Number State | UT
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