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NPI Code Detail

MEDICARE: JASON DEAN TERRY OTR/L

MEDICARE: JASON DEAN TERRY 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
1225X00000XOccupational Therapist10931342-4201UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110931342-4201OTHERUTSTATE OF UTAH DEPT. OF COMMERCE - DOPL
2405734OTHERNBCOT (NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY)

General Provider Information

NPI Number : 1821554874
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON DEAN TERRY OTR/L
Provider Business Mailing Address
First Line : 1034 N 500 W
Second Line :
City : PROVO
State : UT
Zip : 84604-3337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1034 N 500 W
Second Line :
City : PROVO
State : UT
Zip : 84604-3337
Country : US
Telephone Number : 801-357-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2019
Last Update Date : 02/14/2019

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Directions to “ JASON DEAN TERRY OTR/L” Practice Location

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