Healthcare Provider Details

I. General information

NPI: 1154045177
Provider Name (Legal Business Name): MAKAYLA KIRKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N PLAIN RD
JACKSONVILLE NC
28546-6760
US

IV. Provider business mailing address

151B RUTLEDGE AVE # MSC962
CHARLESTON SC
29425-9620
US

V. Phone/Fax

Practice location:
  • Phone: 910-298-2331
  • Fax:
Mailing address:
  • Phone: 843-792-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17685
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: