Provider Demographics
NPI:1417988312
Name:PRISBREY JOHNSON, HEATHER S (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:PRISBREY JOHNSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LOFTY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2578
Mailing Address - Country:US
Mailing Address - Phone:801-541-0612
Mailing Address - Fax:
Practice Address - Street 1:585 LOFTY LN
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2578
Practice Address - Country:US
Practice Address - Phone:801-541-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5156393-4201225XP0200X, 225XM0800X
UT5156393-4201, 62663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265419071Medicare ID - Type Unspecified
UT1912984725Medicare ID - Type Unspecified
UT1619953254Medicare ID - Type Unspecified
UT1326024977Medicare ID - Type Unspecified