MEDICARE: KAYLA LEIGH LILLIBRIDGE BA,QMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073001228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA LEIGH LILLIBRIDGE BA,QMHS

Provider Business Mailing Address
First Line	:	1501 CHESTNUT ST
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-1436
Country	:	US
Telephone Number	:	740-201-2324
Fax Number	:	740-630-0408

Provider Business Practice Location Address
First Line	:	1501 CHESTNUT ST
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-1436
Country	:	US
Telephone Number	:	740-201-2324
Fax Number	:	740-630-0408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	05/18/2022

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