Healthcare Provider Details

I. General information

NPI: 1770943979
Provider Name (Legal Business Name): ASHLEE TAYLOR ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY PKWY # 282
OREM UT
84058-6703
US

IV. Provider business mailing address

3026 E 1610 S
SPANISH FORK UT
84660-8921
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-9928
  • Fax:
Mailing address:
  • Phone: 801-310-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7577781-4810
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: