Provider Demographics
NPI:1326547324
Name:CREEL, KAYLEA JALANE
Entity Type:Individual
Prefix:
First Name:KAYLEA
Middle Name:JALANE
Last Name:CREEL
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 1:1120 N CAUSEWAY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3429
Mailing Address - Country:US
Mailing Address - Phone:985-674-5855
Mailing Address - Fax:985-674-5854
Practice Address - Street 1:1120 N CAUSEWAY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3429
Practice Address - Country:US
Practice Address - Phone:985-674-5855
Practice Address - Fax:985-674-5854
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist