Healthcare Provider Details

I. General information

NPI: 1841689387
Provider Name (Legal Business Name): KAYLA WUEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E BUSINESS WAY
CINCINNATI OH
45241-2374
US

IV. Provider business mailing address

6530 HEARNE RD APT 112
CINCINNATI OH
45248-1180
US

V. Phone/Fax

Practice location:
  • Phone: 513-530-3089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: