Active NPI
Greg Wootton
- Neurorehabilitation Occupational Therapist
- Draper, UT
National Provider Identifier
1972979045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurorehabilitation Occupational Therapist
- License
- 2793404201
- Practice address
- 74 E Kimballs LN Ste 200
Draper, UT 84020-5005 - Phone
- (801) 432-2070
- NPI assigned
- Aug 12, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurorehabilitation Occupational Therapist | 225XN1300X | 2793404201 | UT | Primary |
Addresses
Primary practice location
74 E Kimballs LN Ste 200
Draper, UT 84020-5005
Mailing address
1648 W 1320 N
Provo, UT 84604-2959
Other practice location 1
915 S. 500 E.
Suite 101
American Fork, UT 84003-3357
Phone (801) 692-6830 ext. 1605
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | UT | NONE |
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 |
|---|---|---|---|
| 2793404201 | UT | MD | Neurorehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1972979045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1648 W 1320 N",
"city": "PROVO",
"state": "UT",
"postal_code": "846042959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 E KIMBALLS LN STE 200",
"city": "DRAPER",
"state": "UT",
"postal_code": "840205005",
"telephone_number": "801-432-2070"
}
],
"practiceLocations": [
{
"address_1": "915 S. 500 E.",
"address_2": "Suite 101",
"address_purpose": "LOCATION",
"city": "American Fork",
"state": "UT",
"postal_code": "840033357",
"country_code": "US",
"telephone_number": "801-692-6830 x1605",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOOTTON",
"first_name": "GREG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-12",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225XN1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Neurorehabilitation",
"state": "UT",
"license": "2793404201",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "NONE",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}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 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.