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Individual

PAULA SHIVOCK

Active
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Individual

PAULA SHIVOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAT ATC

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
12014120-4810
UT
2255A2300X
Athletic Trainer

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12014120-4810
LICENSED ATHLETIC TRAINER
UT
01
2000026336
ATHLETIC TRAINER CERTIFIED BOC
Enumeration date
09/23/2015
Last updated
02/24/2022
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