Provider Demographics
NPI:1902024524
Name:COLLARD, KALENE (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:KALENE
Middle Name:
Last Name:COLLARD
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2814
Mailing Address - Country:US
Mailing Address - Phone:801-710-3285
Mailing Address - Fax:
Practice Address - Street 1:2701 UNIVERSITY CIR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-2701
Practice Address - Country:US
Practice Address - Phone:801-626-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6355770-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer