Healthcare Provider Details

I. General information

NPI: 1679442065
Provider Name (Legal Business Name): MAKAYLA JENKINS CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 3300 S
SALT LAKE CITY UT
84109-2635
US

IV. Provider business mailing address

2200 E 3300 S
SALT LAKE CITY UT
84109-2635
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-2096
  • Fax:
Mailing address:
  • Phone: 801-486-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number88527
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: