Provider Demographics
NPI:1386802742
Name:REEVE, RAELENE (COTA/L)
Entity type:Individual
Prefix:
First Name:RAELENE
Middle Name:
Last Name:REEVE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5108
Mailing Address - Country:US
Mailing Address - Phone:801-272-1892
Mailing Address - Fax:
Practice Address - Street 1:4600 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5108
Practice Address - Country:US
Practice Address - Phone:801-272-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4799131-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant