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NPI Code Detail

MEDICARE: GAVIN DALE MCCLELLAN OTR/L

MEDICARE: GAVIN DALE MCCLELLAN OTR/L
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
1225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110250403-4201OTHERUTDOPL

General Provider Information

NPI Number : 1205793510
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAVIN DALE MCCLELLAN OTR/L
Provider Business Mailing Address
First Line : 893 N 900 E
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-1904
Country : US
Telephone Number : 801-822-7699
Fax Number :
Provider Business Practice Location Address
First Line : 1034 N 500 W
Second Line :
City : PROVO
State : UT
Zip : 84604-3380
Country : US
Telephone Number : 801-357-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/30/2026

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Directions to “ GAVIN DALE MCCLELLAN OTR/L” Practice Location

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