Healthcare Provider Details

I. General information

NPI: 1093659666
Provider Name (Legal Business Name): KATY KRYSTINE HANCOCK CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 E BRIGHTON POINT DR
SALT LAKE CITY UT
84121-5513
US

IV. Provider business mailing address

343 W 2350 S
WASHINGTON UT
84780-2278
US

V. Phone/Fax

Practice location:
  • Phone: 801-831-8463
  • Fax:
Mailing address:
  • Phone: 801-368-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number7751655-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: