Provider Demographics
NPI:1710485628
Name:STILLWELL, JAMI
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 E 400 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-4734
Mailing Address - Country:US
Mailing Address - Phone:801-368-8849
Mailing Address - Fax:
Practice Address - Street 1:55 N UNIVERSITY AVE STE 214
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5006
Practice Address - Country:US
Practice Address - Phone:801-368-8849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7470694-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist