Provider Demographics
NPI:1477689016
Name:ANDERSON, MITCHEL SCOTT (OTD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:SCOTT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITE SAGE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-8928
Mailing Address - Country:US
Mailing Address - Phone:435-864-2551
Mailing Address - Fax:435-864-3573
Practice Address - Street 1:130 WHITE SAGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:435-864-2551
Practice Address - Fax:435-864-3573
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5530573-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist