Provider Demographics
NPI:1447708912
Name:EVANS, AUBRIANNE SQUIRE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:AUBRIANNE
Middle Name:SQUIRE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:AUBRIANNE
Other - Middle Name:
Other - Last Name:SQUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:540 S ARAPEEN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1216
Mailing Address - Country:US
Mailing Address - Phone:801-585-6837
Mailing Address - Fax:
Practice Address - Street 1:421 S WAKARA WAY STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-585-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9819526-4201225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics