MEDICARE: SAVANNAH SLATER 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
1	225X00000X	Occupational Therapist	12961713-4201	UT

General Provider Information

NPI Number	:	1548997034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH SLATER OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 711185
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-1185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1227 W 9000 S STE B
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9013
Country	:	US
Telephone Number	:	801-942-3311
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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Directions to “ SAVANNAH SLATER OTR/L” Practice Location

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