MEDICARE: SARA CHURCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	10684127-4002	UT

General Provider Information

NPI Number	:	1114781473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA CHURCH

Provider Business Mailing Address
First Line	:	1245 N 700 E
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-2507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4090 W PIONEER PKWY
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2060
Country	:	US
Telephone Number	:	801-397-4426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/07/2024

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Directions to “ SARA CHURCH ” Practice Location

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