Individual
KAITLYN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
761 W ANTELOPE DR, LAYTON, UT 84041-1630
(801) 779-2620
Mailing address
1080 S 1500 E APT 26, CLEARFIELD, UT 84015-1516
(801) 678-4878
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8986796-4701
UT
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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