Healthcare Provider Details

I. General information

NPI: 1407680820
Provider Name (Legal Business Name): KAYLA MOXLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

V. Phone/Fax

Practice location:
  • Phone: 530-388-6947
  • Fax:
Mailing address:
  • Phone: 530-388-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: