Provider Demographics
NPI:1932742707
Name:BEZZANT, JEFFREY BRANT (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRANT
Last Name:BEZZANT
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 E 1450 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1610
Mailing Address - Country:US
Mailing Address - Phone:801-728-4342
Mailing Address - Fax:801-397-4390
Practice Address - Street 1:1481 E 1450 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1610
Practice Address - Country:US
Practice Address - Phone:801-728-4342
Practice Address - Fax:801-397-4390
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5116725-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5116725-4201Medicaid