Individual
KEITH PRESTGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 MEDICAL DR STE A100, BOUNTIFUL, UT 84010-4995
(801) 683-1062
Mailing address
415 MEDICAL DR STE A100, BOUNTIFUL, UT 84010-4995
(801) 683-1062
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
225X00000X
Occupational Therapist
Primary
14286377-4201
UT
Other
Enumeration date
02/14/2023
Last updated
05/14/2026
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