Individual
JASON DEAN TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3337
(801) 357-7850
Mailing address
1034 N 500 W, PROVO, UT 84604-3337
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
10931342-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10931342-4201
STATE OF UTAH DEPT. OF COMMERCE - DOPL
UT
01
—
405734
NBCOT (NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY)
—
Enumeration date
02/14/2019
Last updated
02/14/2019
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