Provider Demographics
NPI:1194116129
Name:BEASLEY, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ITFS
Mailing Address - Street 1:12450 CLEVELAND RD STE 206
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8355
Mailing Address - Country:US
Mailing Address - Phone:919-771-0775
Mailing Address - Fax:
Practice Address - Street 1:12450 CLEVELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8355
Practice Address - Country:US
Practice Address - Phone:919-771-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty