Healthcare Provider Details

I. General information

NPI: 1215856844
Provider Name (Legal Business Name): KYLIE MICHELLE MORIARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 12TH ST
OGDEN UT
84404-5712
US

IV. Provider business mailing address

1694 E 1425 S
OGDEN UT
84404-8158
US

V. Phone/Fax

Practice location:
  • Phone: 801-335-9382
  • Fax:
Mailing address:
  • Phone: 435-515-6141
  • Fax: 435-515-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: