Healthcare Provider Details

I. General information

NPI: 1255276796
Provider Name (Legal Business Name): ABIGAIL SMALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PROSPECTOR AVE
PARK CITY UT
84060-7320
US

IV. Provider business mailing address

1901 PROSPECTOR AVE # 30
PARK CITY UT
84060-7320
US

V. Phone/Fax

Practice location:
  • Phone: 385-313-0555
  • Fax:
Mailing address:
  • Phone: 385-313-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14258531-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: