MEDICARE: DR. KATY L O'BANION PH.D.

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	103TC0700X	Clinical Psychologist	1090532501	UT

General Provider Information

NPI Number	:	1437149838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATY L O'BANION PH.D.

Provider Business Mailing Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 100
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-272-0390
Fax Number	:	801-272-0118

Provider Business Practice Location Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 100
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-272-0390
Fax Number	:	801-272-0118

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/09/2007

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