Healthcare Provider Details

I. General information

NPI: 1831035187
Provider Name (Legal Business Name): KYLEE LYNN MAFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 S 700 E
SALT LAKE CITY UT
84106-1157
US

IV. Provider business mailing address

88 E PRINCETON DR APT G115
SANDY UT
84070-2197
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-4766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14283100-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: