Healthcare Provider Details

I. General information

NPI: 1366378614
Provider Name (Legal Business Name): JILL TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 311
SALINA UT
84654-0311
US

IV. Provider business mailing address

90 S 100 W
SALINA UT
84654-1102
US

V. Phone/Fax

Practice location:
  • Phone: 435-633-5388
  • Fax:
Mailing address:
  • Phone: 435-633-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14290446-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: