1740686617 NPI number — MISS KAYLA MAE CUNNINGHAM MS, ATC

Table of content: MISS KAYLA MAE CUNNINGHAM MS, ATC (NPI 1740686617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740686617 NPI number — MISS KAYLA MAE CUNNINGHAM MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
KAYLA
Provider Middle Name:
MAE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740686617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 OXBOW CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-6404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 VILLAGE DR
Provider Second Line Business Practice Location Address:
DEPT. 2801
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84408-5150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-626-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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