MEDICARE: YOUR HOME THERAPY LLC

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

General Provider Information

NPI Number	:	1861024440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HOME THERAPY LLC

Provider Business Mailing Address
First Line	:	4209 S MONARCH WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 S MONARCH WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3125
Country	:	US
Telephone Number	:	310-367-7797
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANICE HUANG
Credential	:
Telephone Number	:	310-367-7797

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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