Provider Demographics
NPI:1982292991
Name:SMITH, KAITLYN ROSE ABERNETHY (ATC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE ABERNETHY
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ROSE
Other - Last Name:ABERNETHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:521 S 500 E APT F204
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4181
Mailing Address - Country:US
Mailing Address - Phone:707-365-2789
Mailing Address - Fax:
Practice Address - Street 1:150 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1299
Practice Address - Country:US
Practice Address - Phone:435-283-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11841587-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE