Provider Demographics
NPI:1972111722
Name:EVERETT, KAYLA (MSAT ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MSAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 PINECREEK DR APT F126
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5488
Mailing Address - Country:US
Mailing Address - Phone:760-670-8145
Mailing Address - Fax:
Practice Address - Street 1:2855 PINECREEK DR APT F126
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5488
Practice Address - Country:US
Practice Address - Phone:760-670-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2000039935OtherATC