MEDICARE: OT INNOVATIONS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1578082954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OT INNOVATIONS, LLC

Provider Business Mailing Address
First Line	:	471 CREEKSIDE WAY
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-3140
Country	:	US
Telephone Number	:	801-618-7903
Fax Number	:	844-384-5169

Provider Business Practice Location Address
First Line	:	365 W 1550 N STE H
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2279
Country	:	US
Telephone Number	:	801-618-7903
Fax Number	:	844-384-5169

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NICHOLAS K SIDWELL
Credential	:	OTR/L
Telephone Number	:	801-618-7903

Provider Enumeration Date	:	09/16/2017
Last Update Date	:	03/10/2020

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Directions to “OT INNOVATIONS, LLC ” Practice Location

Language	Start Address	Practice Location

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