Provider Demographics
NPI:1700186699
Name:DIVISION OF OCCUPATIONAL THERAPY UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:DIVISION OF OCCUPATIONAL THERAPY UNIVERSITY OF UTAH
Other - Org Name:LIFE SKILLS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:801-585-7448
Mailing Address - Street 1:520 WAKARA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1213
Mailing Address - Country:US
Mailing Address - Phone:801-585-9135
Mailing Address - Fax:801-585-1001
Practice Address - Street 1:540 ARAPEEN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1250
Practice Address - Country:US
Practice Address - Phone:801-585-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty