Healthcare Provider Details

I. General information

NPI: 1497666812
Provider Name (Legal Business Name): KAYLA IRLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 ARLINGTON AVE
PETOSKEY MI
49770-2469
US

IV. Provider business mailing address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-7486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005610
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: