Provider Demographics
NPI:1346730801
Name:MCNALLY, KAYLIE
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:MCNALLY
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 1:15 PARK VALE AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2631
Mailing Address - Country:US
Mailing Address - Phone:860-942-7522
Mailing Address - Fax:
Practice Address - Street 1:101 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5011
Practice Address - Country:US
Practice Address - Phone:781-551-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency