Provider Demographics
NPI:1477343911
Name:MOSHER, CALLIE GWEN (TRT)
Entity type:Individual
Prefix:MISS
First Name:CALLIE
Middle Name:GWEN
Last Name:MOSHER
Suffix:
Gender:
Credentials:TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E 350 S
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2262
Mailing Address - Country:US
Mailing Address - Phone:801-362-2809
Mailing Address - Fax:801-362-2809
Practice Address - Street 1:2750 N DIGITAL DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6651
Practice Address - Country:US
Practice Address - Phone:385-224-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14217727-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist