Provider Demographics
NPI:1174173710
Name:THIRIOT, KATHLEEN NICHOLE (ATC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NICHOLE
Last Name:THIRIOT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 S 1350 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5320
Mailing Address - Country:US
Mailing Address - Phone:703-622-9379
Mailing Address - Fax:
Practice Address - Street 1:396 S 1350 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5320
Practice Address - Country:US
Practice Address - Phone:703-622-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10834390-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer