Provider Demographics
NPI:1376009415
Name:BODILY, KATY LYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:LYNN
Last Name:BODILY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E BULLRUSH PKWY
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5919
Mailing Address - Country:US
Mailing Address - Phone:801-995-9897
Mailing Address - Fax:
Practice Address - Street 1:625 E BULLRUSH PKWY
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5919
Practice Address - Country:US
Practice Address - Phone:801-995-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7162840-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered