1497040869 NPI number — SUMMIT HAND THERAPY

Table of content: MELINDA NILSEN (NPI 1578438586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497040869 NPI number — SUMMIT HAND THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT HAND THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497040869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1992 W ANTELOPE DR
Provider Second Line Business Mailing Address:
SUITE 1-D
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-4953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-773-2633
Provider Business Mailing Address Fax Number:
801-773-1533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1992 W ANTELOPE DR
Provider Second Line Business Practice Location Address:
SUITE 1-D
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-2633
Provider Business Practice Location Address Fax Number:
801-773-1533
Provider Enumeration Date:
06/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DELONG
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST/ OWNER
Authorized Official Telephone Number:
801-773-2633

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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