Healthcare Provider Details

I. General information

NPI: 1508728296
Provider Name (Legal Business Name): KAYLEIGH NICOLE MAROSEK CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 N 4TH AVE
ILION NY
13357-1634
US

IV. Provider business mailing address

86 N 4TH AVE
ILION NY
13357-1634
US

V. Phone/Fax

Practice location:
  • Phone: 315-360-5801
  • Fax: 315-360-5801
Mailing address:
  • Phone: 315-360-5801
  • Fax: 315-360-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: