MEDICARE: KAYCO THERAPY, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1346936523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYCO THERAPY, LLC

Provider Business Mailing Address
First Line	:	12331 WATERSTONE LN APT 723
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-3046
Country	:	US
Telephone Number	:	419-707-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 N HOLLAND SYLVANIA RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1846
Country	:	US
Telephone Number	:	419-707-9792
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	KASEY CHARLOTTE O'NEAL
Credential	:	MSW, LISW, ACHT
Telephone Number	:	419-707-9792

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/12/2023

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Directions to “KAYCO THERAPY, LLC ” Practice Location

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