MEDICARE: MRS. KAYLEE MOUNCE

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	224Z00000X	Occupational Therapy Assistant	OC60585493	WA

General Provider Information

NPI Number	:	1982076584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLEE MOUNCE

Provider Business Mailing Address
First Line	:	915 HAM HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-5223
Country	:	US
Telephone Number	:	360-490-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 HAM HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-5223
Country	:	US
Telephone Number	:	360-490-9390
Fax Number	:

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

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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