Healthcare Provider Details

I. General information

NPI: 1467392621
Provider Name (Legal Business Name): MRS. KELLY RAE SIVAK DAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL PL
TRYON NC
28782-2942
US

IV. Provider business mailing address

100 SCHOOL PL
TRYON NC
28782-2942
US

V. Phone/Fax

Practice location:
  • Phone: 828-894-3051
  • Fax:
Mailing address:
  • Phone: 828-894-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: