1437678976 NPI number — MRS. KAYLA MICHELLE SPEARS MS OTR/L

Table of content: MRS. KAYLA MICHELLE SPEARS MS OTR/L (NPI 1437678976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437678976 NPI number — MRS. KAYLA MICHELLE SPEARS MS OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEARS
Provider First Name:
KAYLA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAYMOND
Provider Other First Name:
KAYLA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437678976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20470 N LAKE PLEASANT ROAD
Provider Second Line Business Mailing Address:
STE 107
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-248-3324
Provider Business Mailing Address Fax Number:
602-375-8206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20470 N LAKE PLEASANT ROAD
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-248-3324
Provider Business Practice Location Address Fax Number:
602-325-8206
Provider Enumeration Date:
09/15/2017

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: 225X00000X , with the licence number:  7170 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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