Provider Demographics
NPI:1811756810
Name:SIX, SAVANNAH VICTORIA SUMMER
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:VICTORIA SUMMER
Last Name:SIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 E 300 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5155
Mailing Address - Country:US
Mailing Address - Phone:480-262-2535
Mailing Address - Fax:
Practice Address - Street 1:765 E MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1396
Practice Address - Country:US
Practice Address - Phone:385-344-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138356364201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist