Provider Demographics
NPI:1427383827
Name:SPICER, KAYLA RENEA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEA
Last Name:SPICER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:FILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-2905
Mailing Address - Country:US
Mailing Address - Phone:503-310-2094
Mailing Address - Fax:
Practice Address - Street 1:8695 SW JACK BURNS BLVD STE E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5797
Practice Address - Country:US
Practice Address - Phone:503-427-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist