Provider Demographics
NPI:1992460679
Name:CHILDS, KAYLEY SLONE (LAT, PTA, ATC)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:SLONE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LAT, PTA, ATC
Other - Prefix:
Other - First Name:KAYLEY
Other - Middle Name:SLONE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2602 CHAFFEE RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-9998
Mailing Address - Country:US
Mailing Address - Phone:915-400-1005
Mailing Address - Fax:
Practice Address - Street 1:2602 CHAFFEE RD
Practice Address - Street 2:2601 FORT BLISS
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906
Practice Address - Country:US
Practice Address - Phone:915-400-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT55642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer