Healthcare Provider Details

I. General information

NPI: 1588369722
Provider Name (Legal Business Name): KAYLEIGH ANN RYDER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 VAUXHALL ST
NEW LONDON CT
06320-5723
US

IV. Provider business mailing address

394 WESTERLY BRADFORD RD
WESTERLY RI
02891-2616
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-4363
  • Fax:
Mailing address:
  • Phone: 401-744-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: