Provider Demographics
NPI:1073001228
Name:LILLIBRIDGE, KAYLA LEIGH (BA,QMHS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEIGH
Last Name:LILLIBRIDGE
Suffix:
Gender:F
Credentials:BA,QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1436
Mailing Address - Country:US
Mailing Address - Phone:740-201-2324
Mailing Address - Fax:740-630-0408
Practice Address - Street 1:1501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1436
Practice Address - Country:US
Practice Address - Phone:740-201-2324
Practice Address - Fax:740-630-0408
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287885Medicaid