Provider Demographics
NPI:1699491258
Name:ROBERT, KAILEY
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:ROBERT
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 1:27 FORD LN
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6840
Mailing Address - Country:US
Mailing Address - Phone:802-777-1099
Mailing Address - Fax:
Practice Address - Street 1:37 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1032
Practice Address - Country:US
Practice Address - Phone:800-800-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program