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NPI Code Detail

MEDICARE: KAYLA FAIRCLOTH

MEDICARE: KAYLA FAIRCLOTH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1255178687
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA FAIRCLOTH
Provider Business Mailing Address
First Line : 2805 S INDUSTRIAL HWY STE 100
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-6791
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 350 PINECREST ST
Second Line :
City : ALPENA
State : MI
Zip : 49707-1328
Country : US
Telephone Number : 989-278-8878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2024
Last Update Date : 01/03/2025

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Practice Location Address:
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Directions to “ KAYLA FAIRCLOTH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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