Provider Demographics
NPI:1124816467
Name:GRUBB, KAYLA R
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:GRUBB
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 LAUDERMILCH RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8832
Mailing Address - Country:US
Mailing Address - Phone:717-602-2280
Mailing Address - Fax:
Practice Address - Street 1:989 LAUDERMILCH RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-8832
Practice Address - Country:US
Practice Address - Phone:717-602-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA19485225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist