Provider Demographics
NPI:1740340603
Name:WEST, KRISTIN MICHELLE (ATC-L)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:WEST
Suffix:
Gender:F
Credentials:ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 W 1000 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-2211
Mailing Address - Country:US
Mailing Address - Phone:435-753-3585
Mailing Address - Fax:435-716-2809
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:#130
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-716-2882
Practice Address - Fax:435-716-2809
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6344844-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer