Basic Information
Provider Information | |||||||||
NPI: | 1013307313 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAIL | ||||||||
FirstName: | KAELEE | ||||||||
MiddleName: | RAE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTR | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KENDRICK | ||||||||
OtherFirstName: | KAELEE | ||||||||
OtherMiddleName: | RAE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | OTR | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2617 PENDLETON DR | ||||||||
Address2: |   | ||||||||
City: | CEDAR FALLS | ||||||||
State: | IA | ||||||||
PostalCode: | 506131786 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6512389487 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 17480 DALLAS PKWY # 400 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 75287 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4692918500 | ||||||||
FaxNumber: | 2145477328 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2015 | ||||||||
LastUpdateDate: | 05/09/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 076166 | IA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225X00000X | 119951 | TX | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
No ID Information.