MEDICARE: MISS KATY KRYSTINE HANCOCK CTRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	7751655-4002	UT

General Provider Information

NPI Number	:	1093659666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATY KRYSTINE HANCOCK CTRS

Provider Business Mailing Address
First Line	:	343 W 2350 S
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-2278
Country	:	US
Telephone Number	:	801-368-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 E BRIGHTON POINT DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5513
Country	:	US
Telephone Number	:	801-831-8463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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