Basic Information
| Provider Information | |||||||||
| NPI: | 1912403684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | KAYLEIGH | ||||||||
| MiddleName: | GISELE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3325 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 106S00000X | RBT-18-52068 | FL | Y |
No ID Information.