Provider Demographics
NPI:1477751154
Name:WINN, RYAN EDGAR (OTR)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EDGAR
Last Name:WINN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 SOUTH 1000 WEST
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321
Mailing Address - Country:US
Mailing Address - Phone:435-752-5021
Mailing Address - Fax:
Practice Address - Street 1:6810 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6813
Practice Address - Country:US
Practice Address - Phone:435-797-0013
Practice Address - Fax:435-797-0090
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics