Provider Demographics
NPI:1457061350
Name:SOUTHWICK, JANET (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:SOUTHWICK
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:WEBER SCHOOL DISTRICT
Mailing Address - Street 2:5320 ADAMS AVENUE PARKWAY
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WEBER SCHOOL DISTRICT
Practice Address - Street 2:5320 ADAMS AVENUE PARKWAY
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6913
Practice Address - Country:US
Practice Address - Phone:801-476-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT340643-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant