Basic Information
| Provider Information | |||||||||
| NPI: | 1417988312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRISBREY JOHNSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5974 FASHION POINT DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014756800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5974 FASHION POINT DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014756800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5156393-4201, 62663 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.