Provider Demographics
NPI:1952147944
Name:HAMMOND, SERENA (TRS, CTRS)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:TRS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E 1300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1533
Mailing Address - Country:US
Mailing Address - Phone:801-856-5789
Mailing Address - Fax:
Practice Address - Street 1:4179 S RIVERBOAT RD STE 240
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2986
Practice Address - Country:US
Practice Address - Phone:385-312-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87042225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist