Provider Demographics
NPI:1427475615
Name:ZENO, KAYLA (LAT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ZENO
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:4050 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3114
Mailing Address - Country:US
Mailing Address - Phone:262-752-2603
Mailing Address - Fax:
Practice Address - Street 1:3811 SPRING ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405
Practice Address - Country:US
Practice Address - Phone:262-687-5838
Practice Address - Fax:262-687-5895
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1388-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1388-39OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES