Provider Demographics
NPI:1063290930
Name:HENDERSON, CASEY (COTA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:RAUBENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:925 W 2100 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18406 W WHITE QUEST DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84013-9701
Practice Address - Country:US
Practice Address - Phone:801-335-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant