Healthcare Provider Details

I. General information

NPI: 1588424766
Provider Name (Legal Business Name): KAYLA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 MEREDETH CT
LINCOLN NE
68506-5937
US

IV. Provider business mailing address

7910 MEREDETH CT
LINCOLN NE
68506-5937
US

V. Phone/Fax

Practice location:
  • Phone: 573-825-3246
  • Fax:
Mailing address:
  • Phone: 573-825-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1159
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: