Provider Demographics
NPI:1164929899
Name:PEARSON, GARY (OT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S WILLOW XING
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6628
Mailing Address - Country:US
Mailing Address - Phone:801-362-1057
Mailing Address - Fax:
Practice Address - Street 1:2750 N DIGITAL DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6651
Practice Address - Country:US
Practice Address - Phone:385-374-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9811575-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist