Provider Demographics
NPI:1679213003
Name:RICHARDSON, APRIL MICHELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:MICHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 N 4075 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4581
Mailing Address - Country:US
Mailing Address - Phone:801-664-9426
Mailing Address - Fax:
Practice Address - Street 1:1428 N 4075 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4581
Practice Address - Country:US
Practice Address - Phone:801-664-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8352818-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8352818-4202OtherDOPL