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NPI Code Detail

MEDICARE: ANDRIANA S MITNICK MOT

MEDICARE: ANDRIANA S MITNICK MOT
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 Therapist7963826-4201UT

General Provider Information

NPI Number : 1467798363
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRIANA S MITNICK MOT
Provider Business Mailing Address
First Line : 3590 E PALISADE DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-2315
Country : US
Telephone Number : 801-358-7395
Fax Number :
Provider Business Practice Location Address
First Line : 44 N MARIO CAPECCHI DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-587-2394
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2012
Last Update Date : 05/07/2026

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