Healthcare Provider Details

I. General information

NPI: 1881077295
Provider Name (Legal Business Name): KAYLA B SCHNEIDER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA B ALLRED

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE STE 113
APPLETON WI
54913-7862
US

IV. Provider business mailing address

2105 E ENTERPRISE AVE STE 113
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 920-991-2561
  • Fax:
Mailing address:
  • Phone: 920-991-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1460-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: