Provider Demographics
NPI:1932993425
Name:EWING, SHAYLEE ROSE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:ROSE
Last Name:EWING
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 W 3725 N
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9469
Mailing Address - Country:US
Mailing Address - Phone:801-821-0696
Mailing Address - Fax:
Practice Address - Street 1:365 W 1550 N
Practice Address - Street 2:H
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-618-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13199957-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist