Healthcare Provider Details

I. General information

NPI: 1487248563
Provider Name (Legal Business Name): KAYLA BAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 INDEPENDENCE DR
NAPOLEON OH
43545-9194
US

IV. Provider business mailing address

390 INDEPENDENCE DR
NAPOLEON OH
43545-9194
US

V. Phone/Fax

Practice location:
  • Phone: 419-705-1202
  • Fax: 419-599-0635
Mailing address:
  • Phone: 419-705-1202
  • Fax: 419-599-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.022501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: