Provider Demographics
NPI:1316974108
Name:JORGENSEN, JAMES H (OT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E 1000 N STE A
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1870
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:435-896-6662
Practice Address - Street 1:80 E 1000 N STE A
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1870
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:435-896-6662
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328293-2401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT423196OtherPEHP
UT870384752005Medicaid
UTD1785Medicaid
UT225249OtherSELECT HEALTH CARE
UT870384752005Medicaid