=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518854959
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILEIGH SAMANTHA WENDEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9825 N 10800 W
-----------------------------------------------------
City | TREMONTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84337-9222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-643-5057
-----------------------------------------------------
Fax | 866-311-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3194 N CASEY LN
-----------------------------------------------------
City | PLEASANT VIEW
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84414-2295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-726-9104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0500X
-----------------------------------------------------
Taxonomy Name | EEG Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------