Basic Information
| Provider Information | |||||||||
| NPI: | 1508580929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAFFORD | ||||||||
| FirstName: | KAYCE | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 DEMOSS CREEK ACCESS RD | ||||||||
| Address2: | |||||||||
| City: | ATWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382204627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314153543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 GARLAND DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383053654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316643670 | ||||||||
| FaxNumber: | 7316642941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2022 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3878 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.