Provider Demographics
NPI:1467143537
Name:O'GRADY, KAILEY M
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:M
Last Name:O'GRADY
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 1:454 BEACH 124TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1844
Mailing Address - Country:US
Mailing Address - Phone:917-690-6369
Mailing Address - Fax:
Practice Address - Street 1:454 BEACH 124TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1844
Practice Address - Country:US
Practice Address - Phone:917-690-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist