Provider Demographics
NPI:1073106076
Name:FESSENDEN, KAYLEIGH L
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:L
Last Name:FESSENDEN
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 1:1020 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-9598
Mailing Address - Country:US
Mailing Address - Phone:561-601-0830
Mailing Address - Fax:
Practice Address - Street 1:401 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3959
Practice Address - Country:US
Practice Address - Phone:561-601-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty