Healthcare Provider Details

I. General information

NPI: 1346165461
Provider Name (Legal Business Name): MISS KAYLA KHADIJAH WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N 102ND ST STE 300
OMAHA NE
68114-2122
US

IV. Provider business mailing address

2113 HIGHWAY 417
WOODRUFF SC
29388-9447
US

V. Phone/Fax

Practice location:
  • Phone: 186-663-3354
  • Fax:
Mailing address:
  • Phone: 864-804-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4653
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: