Healthcare Provider Details

I. General information

NPI: 1114810561
Provider Name (Legal Business Name): KALEY DIANE BARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYLVIE DIANE BARR

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E EXECUTIVE PARK DR STE 921C
MURRAY UT
84117-7262
US

IV. Provider business mailing address

234 1/2 N SPENCER CT
SALT LAKE CITY UT
84103-2514
US

V. Phone/Fax

Practice location:
  • Phone: 385-831-1204
  • Fax:
Mailing address:
  • Phone: 801-247-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14210575-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: