IndividualActive
Mark Broccardo, COTA
NPI 1376215707 · Occupational Therapy Assistant · Ogden, UT
Provider details
- NPI number
- 1376215707
- Entity type
- Individual
- Primary specialty
- Occupational Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- COTA
- Sex
- Male
- Sole proprietor
- No
- License
- 8703927-4202 (UT)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
3430 Harrison Blvd
Ogden, UT 84403-1231
Phone: (801) 399-5609
Fax: (801) 627-1808
Approximate (ZIP-level) locationGet directions
Mailing address
3430 Harrison Blvd
Ogden, UT 84403-1231
Registry dates
- Enumerated
- 2021-10-04
- Last updated
- 2021-10-04
- Certified
- 2021-10-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.