Healthcare Provider Details

I. General information

NPI: 1346928199
Provider Name (Legal Business Name): KYLEIGH BEATTY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 PAULING STE 200
FOOTHILL RANCH CA
92610-2623
US

IV. Provider business mailing address

25661 INDIAN HILL LN UNIT E
LAGUNA HILLS CA
92653-6046
US

V. Phone/Fax

Practice location:
  • Phone: 949-414-7235
  • Fax:
Mailing address:
  • Phone: 949-414-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: