=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710790118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISSY WOLF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 298 24TH ST STE 140D
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84401-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-294-7204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 298 24TH ST STE 140D
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84401-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-294-7204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 13423484-4701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------