Provider Demographics
NPI:1437988862
Name:ROUNDY, SAVANAH PRISCILLA
Entity type:Individual
Prefix:
First Name:SAVANAH
Middle Name:PRISCILLA
Last Name:ROUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E 1400 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7707
Mailing Address - Country:US
Mailing Address - Phone:801-499-4369
Mailing Address - Fax:
Practice Address - Street 1:575 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7707
Practice Address - Country:US
Practice Address - Phone:801-499-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14035616-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist