Healthcare Provider Details

I. General information

NPI: 1477467363
Provider Name (Legal Business Name): KAILYNN MARSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 SW PARK AVE
LAWTON OK
73505-7902
US

IV. Provider business mailing address

3005 SW PARK AVE
LAWTON OK
73505-7902
US

V. Phone/Fax

Practice location:
  • Phone: 580-699-5558
  • Fax: 580-699-5559
Mailing address:
  • Phone: 580-699-5558
  • Fax: 580-699-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: