Provider Demographics
NPI:1215617394
Name:MURDOCK, ADRIANE FOX (OTR/L)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:FOX
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:FOX
Other - Last Name:HEINEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1427 N 630 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9513
Mailing Address - Country:US
Mailing Address - Phone:801-510-6839
Mailing Address - Fax:
Practice Address - Street 1:1427 N 630 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-9513
Practice Address - Country:US
Practice Address - Phone:801-510-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6189212-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist