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NPI Code Detail

MEDICARE: EMILY BURDITT MOT, OTR/L

MEDICARE: EMILY BURDITT MOT, 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 Therapist118976TX
2225X00000XOccupational Therapist11544970-4201UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1118976OTHERTXTBOTE

General Provider Information

NPI Number : 1851949325
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY BURDITT MOT, OTR/L
Provider Business Mailing Address
First Line : 255 S UNIVERSITY AVE APT A410
Second Line :
City : PROVO
State : UT
Zip : 84601-4498
Country : US
Telephone Number : 903-771-8451
Fax Number :
Provider Business Practice Location Address
First Line : 18406 W WHITE QUEST DR
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84013-9701
Country : US
Telephone Number : 801-355-4699
Fax Number : 801-355-7031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2019
Last Update Date : 08/24/2021

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