Provider Demographics
NPI:1003679747
Name:CARROTHERS, KAYLA RAE'ANNA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE'ANNA
Last Name:CARROTHERS
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 1:13973 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5403
Mailing Address - Country:US
Mailing Address - Phone:734-855-4490
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:13973 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5403
Practice Address - Country:US
Practice Address - Phone:734-855-4490
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician