Provider Demographics
NPI:1972091346
Name:PRICE, KAILEY JEAN VII (COTA/L)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:JEAN
Last Name:PRICE
Suffix:VII
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:JEAN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MI
Mailing Address - Zip Code:49406-0217
Mailing Address - Country:US
Mailing Address - Phone:269-857-2141
Mailing Address - Fax:
Practice Address - Street 1:243 WILEY RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MI
Practice Address - Zip Code:49406-5108
Practice Address - Country:US
Practice Address - Phone:269-857-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007785224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant