# LYMPHEDEMA SPECIALTY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972451680
- **Authorized official:** KONNIE ROBERTS OT (OWNER)
- **Authorized official phone:** (801) 232-5616

## Contact information

- **Practice address:** 4711 W MOSSLEY BEND DR, HERRIMAN, UT 84096-2436
- **Practice address phone:** (801) 232-5616
- **Mailing address:** 4711 W MOSSLEY BEND DR, HERRIMAN, UT 84096-2436
- **Mailing address phone:** (801) 232-5616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2026
- **Last updated:** 03/18/2026