Healthcare Provider Details

I. General information

NPI: 1386821205
Provider Name (Legal Business Name): LONI LYNN WILEY M.S, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N 11TH AVE
BOZEMAN MT
59715-3217
US

IV. Provider business mailing address

305 E JEFFERSON AVE
BELGRADE MT
59714-4132
US

V. Phone/Fax

Practice location:
  • Phone: 406-581-5073
  • Fax:
Mailing address:
  • Phone: 406-579-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: