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General NPI Number Information
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NPI Number | 1871314914
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Entity Type | Individual
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Provider Name | JESSICA CARLILE
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 2348 KIESEL AVE
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City | OGDEN
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State | UT
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Zip | 84401-1964
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Country | US
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Telephone | 801-528-5066
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Fax |
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Provider Business Mailing Address
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Address Line | 289 E 1500 N
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City | HARRISVILLE
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State | UT
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Zip | 84404-7729
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Country | US
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Telephone | 801-678-1408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11946279-4701
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License Number State | UT
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