Healthcare Provider Details

I. General information

NPI: 1942615216
Provider Name (Legal Business Name): KESLER KONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10197 N 5750 W
HIGHLAND UT
84003-9143
US

IV. Provider business mailing address

10197 N 5750 W
HIGHLAND UT
84003-9143
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number76991021204
License Number StateUT

VIII. Authorized Official

Name: DR. CAMERON KESLER
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 801-602-1511