MEDICARE: ASHLEY K RUDD

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	224Z00000X	Occupational Therapy Assistant	12326686-4202	UT

General Provider Information

NPI Number	:	1932805884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY K RUDD

Provider Business Mailing Address
First Line	:	2660 S 8550 W
Second Line	:
City	:	MAGNA
State	:	UT
Zip	:	84044-1211
Country	:	US
Telephone Number	:	801-787-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2199
Country	:	US
Telephone Number	:	385-743-8360
Fax Number	:

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

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	02/02/2023

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