Provider Demographics
NPI:1124685706
Name:GRAY, KAYLA (MED)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 BEDFORD AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2647
Mailing Address - Country:US
Mailing Address - Phone:614-314-2357
Mailing Address - Fax:
Practice Address - Street 1:5041 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1433
Practice Address - Country:US
Practice Address - Phone:513-889-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator