Provider Demographics
NPI:1114764982
Name:PHILLIPS, KAYLA R
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 TOURMALINE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6149
Mailing Address - Country:US
Mailing Address - Phone:570-269-2111
Mailing Address - Fax:
Practice Address - Street 1:4964 N PALM AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9111
Practice Address - Country:US
Practice Address - Phone:321-228-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician