Provider Demographics
NPI:1992070460
Name:HENRIE, JASON JAMES (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:HENRIE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 E 750 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3224
Mailing Address - Country:US
Mailing Address - Phone:801-489-4461
Mailing Address - Fax:
Practice Address - Street 1:1068 E 200 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2712
Practice Address - Country:US
Practice Address - Phone:801-489-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7712326-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist