MEDICARE: MARGARET SMEDLEY RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	265417-4901	UT

General Provider Information

NPI Number	:	1063292357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET SMEDLEY RD

Provider Business Mailing Address
First Line	:	437 E SOUTHFORK DR
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8755
Country	:	US
Telephone Number	:	801-680-7858
Fax Number	:

Provider Business Practice Location Address
First Line	:	5063 S COTTONWOOD ST STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6772
Country	:	US
Telephone Number	:	801-507-7038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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