Organization
LEGENDARY PEDIATRIC THERAPY
Active
Other names
Functionabilities, Functionabilities
Organization subpart
No
Provider details
NPI number
Authorized official
BREEANN MILLETTE (BILLING MANAGER)
(801) 443-7775
Entity
Organization
Contact information
Practice address
12453 S 265 W STE B, DRAPER, UT 84020-5420
(801) 443-7775
(801) 447-0107
Mailing address
12453 S 265 W STE B, DRAPER, UT 84020-5420
(801) 443-7775
(801) 447-0107
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
5044485-4701
UT
225X00000X
Occupational Therapist
5044485-4201
UT
225X00000X
Occupational Therapist
Primary
6717450-4201
UT
235Z00000X
Speech-Language Pathologist
9554558-4102
UT
Other
Enumeration date
12/02/2014
Last updated
04/09/2026
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