Provider Demographics
NPI:1740427285
Name:SAKS, CARRIE L (OTRL)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:SAKS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S 500 E
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1959
Mailing Address - Country:US
Mailing Address - Phone:801-587-6336
Mailing Address - Fax:801-715-8228
Practice Address - Street 1:540 S ARAPEEN DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1250
Practice Address - Country:US
Practice Address - Phone:801-587-6336
Practice Address - Fax:801-715-8228
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-007231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0028740Medicaid
OH9290211Medicare PIN