MEDICARE: ALICE CAITLIN FLINT OT

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	12535857-4201	UT

General Provider Information

NPI Number	:	1619741402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE CAITLIN FLINT OT

Provider Business Mailing Address
First Line	:	8916 S 1240 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-1906
Country	:	US
Telephone Number	:	207-975-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:	801-261-3664
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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