Active NPI
Deanna Mackay-Clark, OTR
- Occupational Therapist
- West Jordan, UT
National Provider Identifier
1851497580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1088554201
- Practice address
- 9301 South Wights Fort Rd
Suite 215
West Jordan, UT 84088 - Phone
- (801) 282-2200
- Fax
- (801) 282-2220
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1088554201 | UT | Primary |
Addresses
Primary practice location
9301 South Wights Fort Rd
Suite 215
West Jordan, UT 84088
Mailing address
PO Box 711185
Salt Lake City, UT 84171
Phone (801) 942-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L0295 | Medicaid | UT |
Other names 1
- Alice Deanna Mackay
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1088554201 | UT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Land Rehabilitation LLC | Occupational Therapist | Past | Accepting new patients |
| Registered Physical Therapists LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Salt Lake City, UT
- NPI 1265549372
Occupational Therapist
-
- Physical Therapy Clinic/Center
- Sandy, UT
- NPI 1477582633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851497580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 711185",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84171",
"telephone_number": "801-942-3311",
"fax_number": "801-942-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9301 SOUTH WIGHTS FORT RD",
"address_2": "SUITE 215",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "84088",
"telephone_number": "801-282-2200",
"fax_number": "801-282-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKAY-CLARK",
"first_name": "DEANNA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "UT",
"license": "1088554201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "L0295",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ALICE",
"last_name": "MACKAY",
"middle_name": "DEANNA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.