Healthcare Provider Details

I. General information

NPI: 1043135510
Provider Name (Legal Business Name): MAKYLAH JEAN LADD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5948 S SILVER FOX DR APT 22
KEARNS UT
84118-8070
US

IV. Provider business mailing address

5948 S SILVER FOX DR APT 22
KEARNS UT
84118-8070
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-3426
  • Fax:
Mailing address:
  • Phone: 801-915-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14304157-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: