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Ellison Kruckenberg, COTA/L
NPI 1386100402 · on the registry since 2019 · sole proprietor
Practice
- Address
- 401 S 400 E
Bountiful, UT 84010 - Phone
- (801) 295-2361
- Organisation at this address
- Beaver Valley Hospital
Holbrook Healthcare Llc
Providential Bba Operating Lp
Providential Bba Operating LpInferred from a shared address, not stated in the registry. - Clinicians at this address
- 20
Registry record
- Primary taxonomy
- Occupational Therapy Assistant
224Z00000X
- Licence states on file
- UT
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-07-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah