Provider Demographics
NPI:1275392995
Name:SLEIGHT, AMBER CARYL (TRTU)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CARYL
Last Name:SLEIGHT
Suffix:
Gender:F
Credentials:TRTU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 N 200 E
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-1303
Mailing Address - Country:US
Mailing Address - Phone:435-723-7777
Mailing Address - Fax:435-723-8773
Practice Address - Street 1:775 N 200 E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-1303
Practice Address - Country:US
Practice Address - Phone:435-723-7777
Practice Address - Fax:435-723-8773
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5110129-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist