MEDICARE: KAYLA MURPHY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598201758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MURPHY

Provider Business Mailing Address
First Line	:	4970 E GAUTHIER RD
Second Line	:
City	:	CEDAR
State	:	MI
Zip	:	49621-9662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1363 DOUGLAS DR
Second Line	:	SUITE 104
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:	231-668-4909
Fax Number	:

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

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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Directions to “ KAYLA MURPHY ” Practice Location

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