Provider Demographics
NPI:1043488570
Name:WELLMAN, MICHELLE D (OT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:ROBLYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:572 S CROOKED POST WAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5449
Mailing Address - Country:US
Mailing Address - Phone:509-851-3791
Mailing Address - Fax:801-285-4301
Practice Address - Street 1:3741 W 12600 S STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7215
Practice Address - Country:US
Practice Address - Phone:801-285-3400
Practice Address - Fax:801-285-3401
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001051224Z00000X
WAOT61194912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant