MEDICARE: KAILEY SPICER

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1205591781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY SPICER

Provider Business Mailing Address
First Line	:	3965 CROWN SHORE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-7226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 HARVEST HILL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1607
Country	:	US
Telephone Number	:	214-360-7500
Fax Number	:

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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Directions to “ KAILEY SPICER ” Practice Location

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