Healthcare Provider Details

I. General information

NPI: 1891629135
Provider Name (Legal Business Name): KAILE REX
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12272 S 800 E STE D
DRAPER UT
84020-9776
US

IV. Provider business mailing address

724 W 1720 N
PROVO UT
84604-2486
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-3537
  • Fax:
Mailing address:
  • Phone: 562-336-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: