Provider Demographics
NPI:1316589427
Name:WHALEY, KAYLA CHRISTINE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHRISTINE
Last Name:WHALEY
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 1:212 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1641
Mailing Address - Country:US
Mailing Address - Phone:812-318-6223
Mailing Address - Fax:
Practice Address - Street 1:1713 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2478
Practice Address - Country:US
Practice Address - Phone:812-337-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21104133225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist