Provider Demographics
NPI:1285198333
Name:MCCOLLOR, KAYLA LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LYNN
Last Name:MCCOLLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38743 N BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9106
Mailing Address - Country:US
Mailing Address - Phone:847-721-8065
Mailing Address - Fax:
Practice Address - Street 1:310 S GREENLEAF ST STE 208
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-623-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist