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General NPI Number Information
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NPI Number | 1740170224
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Entity Type | Individual
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Provider Name | BLAKE UREDNICK OTR/L
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 382 E 400 S STE A
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City | SPRINGVILLE
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State | UT
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Zip | 84663-1992
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Country | US
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Telephone | 801-997-9148
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Fax |
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Provider Business Mailing Address
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Address Line | 802 S 1100 W
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City | SPANISH FORK
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State | UT
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Zip | 84660-5718
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Country | US
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Telephone | 574-361-8942
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 14207410-4201
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License Number State | UT
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