Provider Demographics
NPI:1780828749
Name:MUDROW, NATALIE TIPPETS
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:TIPPETS
Last Name:MUDROW
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:TIPPETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1506 UNIVERSITY VLG
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3522
Mailing Address - Country:US
Mailing Address - Phone:801-585-4851
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist