Healthcare Provider Details

I. General information

NPI: 1811847288
Provider Name (Legal Business Name): KAILANI WILCOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E BISHOP FEDERAL LN
SALT LAKE CITY UT
84115-2357
US

IV. Provider business mailing address

385 S CENTER ST
GRANTSVILLE UT
84029-9743
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-7557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number93012464003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: