Healthcare Provider Details

I. General information

NPI: 1518806181
Provider Name (Legal Business Name): KAYLA FORDHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 1ST ST
DIXON IL
61021-3166
US

IV. Provider business mailing address

403 E 1ST ST
DIXON IL
61021-3116
US

V. Phone/Fax

Practice location:
  • Phone: 815-285-5591
  • Fax:
Mailing address:
  • Phone: 815-285-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.009218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: