Healthcare Provider Details

I. General information

NPI: 1851206346
Provider Name (Legal Business Name): MIYA MAXFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 E 1000 N
RICHFIELD UT
84701-1880
US

IV. Provider business mailing address

113 S MAIN ST
SIGURD UT
84657-7735
US

V. Phone/Fax

Practice location:
  • Phone: 435-896-8211
  • Fax:
Mailing address:
  • Phone: 435-558-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14300398-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: