Provider Demographics
NPI:1063530004
Name:WRIGHT, JAYME NICOLE (MS ATC LAT)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:NICOLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 700 N
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-734-0070
Mailing Address - Fax:
Practice Address - Street 1:270 12TH ST
Practice Address - Street 2:STE B
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404
Practice Address - Country:US
Practice Address - Phone:801-337-4000
Practice Address - Fax:801-337-4002
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342869-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT429841802003Medicare ID - Type Unspecified
U77156Medicare UPIN