Provider Demographics
NPI:1811135262
Name:OVIATT, KELLY A
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:OVIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 S 3200 W
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-2800
Mailing Address - Country:US
Mailing Address - Phone:801-808-5826
Mailing Address - Fax:801-994-0553
Practice Address - Street 1:7625 S 3200 W
Practice Address - Street 2:STE 1
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2800
Practice Address - Country:US
Practice Address - Phone:801-808-5826
Practice Address - Fax:801-994-0553
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical