MEDICARE: MS. KATHRYN DIANE ELTON 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	276684-4201	UT

General Provider Information

NPI Number	:	1619128279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN DIANE ELTON OTR/L

Provider Business Mailing Address
First Line	:	3087 S 3380 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-4236
Country	:	US
Telephone Number	:	801-906-0926
Fax Number	:	801-906-0926

Provider Business Practice Location Address
First Line	:	3087 S 3380 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-4236
Country	:	US
Telephone Number	:	805-550-3513
Fax Number	:	801-906-0926

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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