Basic Information
| Provider Information | |||||||||
| NPI: | 1568120376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAHELI | ||||||||
| FirstName: | PAIGE | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 E GORDON AVE | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840412341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016634316 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1438 N HIGHWAY 89 STE 130 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840252737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016634316 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2021 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | UT | Y |
No ID Information.