Provider Demographics
NPI:1407545973
Name:BUSKELL, KAYLEE RAYE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RAYE
Last Name:BUSKELL
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 1:309 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-3051
Mailing Address - Country:US
Mailing Address - Phone:810-835-9559
Mailing Address - Fax:
Practice Address - Street 1:309 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-3051
Practice Address - Country:US
Practice Address - Phone:810-835-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X, 167G00000X, 183700000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No183700000XPharmacy Service ProvidersPharmacy Technician