Provider Demographics
NPI:1396503132
Name:TRAMMELL, TARALEE
Entity type:Individual
Prefix:
First Name:TARALEE
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900292
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-0292
Mailing Address - Country:US
Mailing Address - Phone:801-633-2953
Mailing Address - Fax:
Practice Address - Street 1:7181 S CAMPUS VIEW DR STE 1A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-4312
Practice Address - Country:US
Practice Address - Phone:801-613-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6126966-4002171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor