Provider Demographics
NPI:1437735602
Name:PERLOTTO, KAYLEIGH GLYNN (LRT/CTRS, CDP)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:GLYNN
Last Name:PERLOTTO
Suffix:
Gender:F
Credentials:LRT/CTRS, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 W MCNEESE ST APT 8214
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4507
Mailing Address - Country:US
Mailing Address - Phone:404-285-0422
Mailing Address - Fax:
Practice Address - Street 1:302 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5604
Practice Address - Country:US
Practice Address - Phone:337-474-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist