Provider Demographics
NPI:1407134232
Name:WOODBURY, JASON (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WOODBURY
Suffix:
Gender:M
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 1:1551 S 125 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7677
Mailing Address - Country:US
Mailing Address - Phone:801-765-7585
Mailing Address - Fax:
Practice Address - Street 1:575 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7707
Practice Address - Country:US
Practice Address - Phone:801-225-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-993225X00000X
ID7021811-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist