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General NPI Number Information
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NPI Number | 1891606729
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Entity Type | Individual
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Provider Name | AUDREY CHECKETTS
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Gender | Female
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 1205 E BONNER WAY
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City | MILLCREEK
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State | UT
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Zip | 84117-4917
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Country | US
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Telephone | 801-262-2908
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Fax |
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Provider Business Mailing Address
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Address Line | 668 E 700 N
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City | TOOELE
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State | UT
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Zip | 84074-3706
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Country | US
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Telephone |
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 143101644003
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License Number State | UT
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