Provider Demographics
NPI:1427864339
Name:MIGNOTT, KAYLA TIFFANY
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:TIFFANY
Last Name:MIGNOTT
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 1:1112 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1552
Mailing Address - Country:US
Mailing Address - Phone:908-531-6339
Mailing Address - Fax:
Practice Address - Street 1:1118 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1261
Practice Address - Country:US
Practice Address - Phone:732-637-4323
Practice Address - Fax:732-362-7832
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01215300225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics