Provider Demographics
NPI:1073388765
Name:KLEE, KACIE LEE
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:LEE
Last Name:KLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:LEE
Other - Last Name:BAYREUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 4TH AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1809
Practice Address - Country:US
Practice Address - Phone:860-885-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist