Provider Demographics
NPI:1003493255
Name:TAGGART, KAYLA DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:TAGGART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:DAWN
Other - Last Name:TACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 POSEY LN APT 104
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2284
Mailing Address - Country:US
Mailing Address - Phone:740-541-9509
Mailing Address - Fax:
Practice Address - Street 1:60 PACELINE CIR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1281
Practice Address - Country:US
Practice Address - Phone:937-915-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant