NPI 1386100402

Ellison M Kruckenberg, COTAL

Practitioner Occupational Therapy Assistant Bountiful, UT

Practice location

Address: 401 S 400 E, Bountiful, UT 84010-4933
Phone: (801) 295-2361
Mailing address: 9487 S Wasatch Downs Cir, South Jordan, UT 84095-9289

Registered specialties

Occupational Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224Z00000X Licence 12931092-4202 (UT)

Other Occupational Therapy Assistant providers in Utah →

Registry record

NPI: 1386100402
Entity type: Individual
Sex (as registered): Female
NPI issued: 13 Feb 2019
Record last updated: 12 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.