NPIMap

Organization Active NPI

Legendary Pediatric Therapy

Doing business as Functionabilities

  • Occupational Therapist
  • Draper, UT
National Provider Identifier
1568869899
Registry record updated Oct 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6717450-4201 Issued in UT
Legal business name
LEGENDARY PEDIATRIC THERAPY
Practice address
12453 S 265 W Ste B
Draper, UT 84020-5420
Phone
(801) 443-7775
Fax
(801) 447-0107
NPI assigned
Dec 2, 2014
Last updated
Oct 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Breeann Millette
Title
Billing Manager
Phone
(801) 443-7775

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X NU
Occupational Therapist 225X00000X 6717450-4201 UT Primary
Speech-Language Pathologist 235Z00000X 9554558-4102 UT

Addresses

Primary practice location

12453 S 265 W Ste B
Draper, UT 84020-5420

Mailing address

12453 S 265 W Ste B
Draper, UT 84020-5420
Phone (801) 443-7775

Other practice location 1

135 W 900 N
Springville, UT 84663-1095
Phone (801) 443-7775

Other names 1

  • Functionabilities Former legal business name

National Provider Directory

National Provider Directory

Locations

12453 S 265 W
Ste B
Draper, UT 84020
Phone (801) 443-7775

75 W Center St
Provo, UT 84601
Phone (801) 472-5381

9384 S 670 W
Sandy, UT 84070
Phone (800) 472-9515

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791763200000",
    "number": "1568869899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12453 S 265 W STE B",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205420",
            "telephone_number": "801-443-7775",
            "fax_number": "801-447-0107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12453 S 265 W STE B",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205420",
            "telephone_number": "801-443-7775",
            "fax_number": "801-447-0107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 W 900 N",
            "address_purpose": "LOCATION",
            "city": "Springville",
            "state": "UT",
            "postal_code": "846631095",
            "country_code": "US",
            "telephone_number": "801-443-7775",
            "fax_number": "801-407-0107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGENDARY PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A",
        "authorized_official_last_name": "MILLETTE",
        "authorized_official_first_name": "BREEANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-443-7775"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "UT",
            "license": "6717450-4201",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "UT",
            "license": "9554558-4102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Functionabilities",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Functionabilities",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.