Provider Demographics
NPI:1326422262
Name:HOWELL, MIRANDA (OT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HOWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N 800 E
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1963
Mailing Address - Country:US
Mailing Address - Phone:801-318-0412
Mailing Address - Fax:
Practice Address - Street 1:345 N 800 E
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1963
Practice Address - Country:US
Practice Address - Phone:801-318-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11632225X00000X
UT9428182-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist