Provider Demographics
NPI:1750097374
Name:OATES, DENIECE DAVENPORT (ATC, LATC)
Entity type:Individual
Prefix:
First Name:DENIECE
Middle Name:DAVENPORT
Last Name:OATES
Suffix:
Gender:F
Credentials:ATC, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 E 710 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1325
Mailing Address - Country:US
Mailing Address - Phone:801-755-9304
Mailing Address - Fax:
Practice Address - Street 1:110 INDOOR PRACTICE FACILITY BRIGHAM
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-2000
Practice Address - Country:US
Practice Address - Phone:801-422-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1294024062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer