Provider Demographics
NPI:1114810561
Name:BARR, KALEY DIANE
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:DIANE
Last Name:BARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYLVIE
Other - Middle Name:DIANE
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:234 1/2 N SPENCER CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2514
Mailing Address - Country:US
Mailing Address - Phone:801-247-8856
Mailing Address - Fax:
Practice Address - Street 1:921 E EXECUTIVE PARK DR STE 921C
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7262
Practice Address - Country:US
Practice Address - Phone:385-831-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14210575-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist