Healthcare Provider Details

I. General information

NPI: 1336741024
Provider Name (Legal Business Name): KAYLA ALICIA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

1409 LONSDALE RD
COLUMBUS OH
43232-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-3800
  • Fax:
Mailing address:
  • Phone: 614-313-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207274
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: