Provider Demographics
NPI:1417690371
Name:TRUJILLO, ANN M (OTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:280 W 940 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3394
Mailing Address - Country:US
Mailing Address - Phone:801-374-4800
Mailing Address - Fax:
Practice Address - Street 1:280 W 940 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3394
Practice Address - Country:US
Practice Address - Phone:801-374-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11157546-4202224Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant