Healthcare Provider Details

I. General information

NPI: 1033034947
Provider Name (Legal Business Name): MIA KATE BURTCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 E 9400 S
SANDY UT
84094-3655
US

IV. Provider business mailing address

441 S 940 W
OREM UT
84058-5950
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-2556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: