Healthcare Provider Details

I. General information

NPI: 1376314518
Provider Name (Legal Business Name): KYLEE LEAVITT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 WATERTON LN
APEX NC
27502-9003
US

IV. Provider business mailing address

920 US 64 HWY W # 1022
APEX NC
27523-7184
US

V. Phone/Fax

Practice location:
  • Phone: 435-680-0768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KYLEE LEAVITT
Title or Position: OWNER
Credential:
Phone: 435-680-0768