Provider Demographics
NPI:1164308128
Name:RADMALL, JEREMY B (OTR/L)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:B
Last Name:RADMALL
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 1:1992 W ANTELOPE DR STE 1D
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4974
Mailing Address - Country:US
Mailing Address - Phone:801-689-2389
Mailing Address - Fax:801-689-3215
Practice Address - Street 1:2850 N 2000 W STE 107
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9230
Practice Address - Country:US
Practice Address - Phone:801-689-2389
Practice Address - Fax:801-689-3215
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106004410-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist