Basic Information
| Provider Information | |||||||||
| NPI: | 1972863546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STONEBRAKER | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 936 W 1290 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT GROVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840629214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015600008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 ALPINE AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANT GROVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840623511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017853568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2012 | ||||||||
| LastUpdateDate: | 05/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 7905154-4201 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.