Individual
KAELI ARCHIBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
1345 W 1600 N, PROVO, UT 84604-2301
(208) 701-5264
Mailing address
1345 W 1600 N, PROVO, UT 84604-2301
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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