Provider Demographics
NPI:1194565887
Name:STEELE, ROLANDA DAISY
Entity type:Individual
Prefix:
First Name:ROLANDA
Middle Name:DAISY
Last Name:STEELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROLANDA
Other - Middle Name:DAISY
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 E 5250 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6629
Mailing Address - Country:US
Mailing Address - Phone:801-458-1253
Mailing Address - Fax:
Practice Address - Street 1:152 E 5250 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405-6629
Practice Address - Country:US
Practice Address - Phone:801-458-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7345226-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist