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NPI Code Detail

MEDICARE: MR. JEFFREY BRANT BEZZANT OCCUPATIONAL THERAPI

MEDICARE: MR. JEFFREY BRANT BEZZANT OCCUPATIONAL THERAPI
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 Therapist5116725-4201UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932742707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY BRANT BEZZANT OCCUPATIONAL THERAPI
Provider Business Mailing Address
First Line : 1481 E 1450 S
Second Line :
City : CLEARFIELD
State : UT
Zip : 84015-1610
Country : US
Telephone Number : 801-728-4342
Fax Number : 801-397-4390
Provider Business Practice Location Address
First Line : 1481 E 1450 S
Second Line :
City : CLEARFIELD
State : UT
Zip : 84015-1610
Country : US
Telephone Number : 801-728-4342
Fax Number : 801-397-4390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 10/23/2019

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