IndividualActive
Ellison Kruckenberg, COTA/L
NPI 1386100402 · Occupational Therapy Assistant · Bountiful, UT
Provider details
- NPI number
- 1386100402
- Entity type
- Individual
- Primary specialty
- Occupational Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- COTA/L
- Sex
- Female
- Sole proprietor
- Yes
- License
- 12931092-4202 (UT)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
401 S 400 E
Bountiful, UT 84010-4933
Phone: (801) 295-2361
Approximate (ZIP-level) locationGet directions
Mailing address
9487 S Wasatch Downs Cir
South Jordan, UT 84095-9289
Registry dates
- Enumerated
- 2019-02-13
- Last updated
- 2022-07-12
- Certified
- 2022-07-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.