Active NPI
Amber Peacock
- Recreation Therapist
- Salt Lake City, UT
National Provider Identifier
1861258709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 5848356-4003
- Practice address
- 3855 S 700 E
Salt Lake City, UT 84106-1157 - Phone
- (801) 268-4766
- Fax
- (801) 262-2145
- NPI assigned
- Feb 27, 2024
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 5848356-4003 | UT | Primary |
Addresses
Primary practice location
3855 S 700 E
Salt Lake City, UT 84106-1157
Mailing address
4114 W Bella Bluff Dr
Herriman, UT 84096-1920
Phone (801) 694-4491
Other practice location 1
835 E Vine St
Murray, UT 84107-6515
Phone (801) 694-4491
Other practice location 2
4114 W Bella Bluff Dr
Herriman, UT 84096-1920
Phone (801) 694-4991
Other practice location 3
3855 S 700 E
Millcreek, UT 84106-1157
Phone (801) 694-4491
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5848356-4003 | UT | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710892800000",
"number": "1861258709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4114 W BELLA BLUFF DR",
"city": "HERRIMAN",
"state": "UT",
"postal_code": "840961920",
"telephone_number": "801-694-4491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3855 S 700 E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841061157",
"telephone_number": "801-268-4766",
"fax_number": "801-262-2145"
}
],
"practiceLocations": [
{
"address_1": "835 E Vine St",
"address_purpose": "LOCATION",
"city": "Murray",
"state": "UT",
"postal_code": "841076515",
"country_code": "US",
"telephone_number": "801-694-4491",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4114 W Bella Bluff Dr",
"address_purpose": "LOCATION",
"city": "Herriman",
"state": "UT",
"postal_code": "840961920",
"country_code": "US",
"telephone_number": "801-694-4991",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3855 S 700 E",
"address_purpose": "LOCATION",
"city": "Millcreek",
"state": "UT",
"postal_code": "841061157",
"country_code": "US",
"telephone_number": "801-694-4491",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEACOCK",
"first_name": "AMBER",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-27",
"last_updated": "2024-03-20",
"certification_date": "2024-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "UT",
"license": "5848356-4003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.