Provider Demographics
NPI:1053330597
Name:WOODEN, THERESA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:WOODEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 N 1375 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-3419
Mailing Address - Country:US
Mailing Address - Phone:801-782-5935
Mailing Address - Fax:801-782-5136
Practice Address - Street 1:2762 N 1375 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-3419
Practice Address - Country:US
Practice Address - Phone:801-782-5935
Practice Address - Fax:801-782-5136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378913-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist