Provider Demographics
NPI:1922192798
Name:ROBINSON, TERA CARPENTER (OTR / L)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:CARPENTER
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OTR / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-588-2000
Mailing Address - Fax:
Practice Address - Street 1:2955 HARRISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0982
Practice Address - Country:US
Practice Address - Phone:801-395-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5073709-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist