Healthcare Provider Details

I. General information

NPI: 1689563363
Provider Name (Legal Business Name): KAILY HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TURNPIKE RD STE 101
SOUTHBOROUGH MA
01772-1755
US

IV. Provider business mailing address

50 STAPLES RD
CUMBERLAND RI
02864-1420
US

V. Phone/Fax

Practice location:
  • Phone: 508-970-6377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: