Provider Demographics
NPI:1386821205
Name:WILEY, LONI LYNN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LONI
Middle Name:LYNN
Last Name:WILEY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-4132
Mailing Address - Country:US
Mailing Address - Phone:406-579-1637
Mailing Address - Fax:
Practice Address - Street 1:205 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3217
Practice Address - Country:US
Practice Address - Phone:406-581-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer