Provider Demographics
NPI:1295553154
Name:KETCHUM, ABIGAIL RULA-MAY (ATS)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RULA-MAY
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E 250 S HPER WEST
Mailing Address - Street 2:ROOM 113
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-585-1820
Mailing Address - Fax:
Practice Address - Street 1:1850 E 250 S HPER WEST
Practice Address - Street 2:ROOM 113
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-585-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program