Provider Demographics
NPI:1487227245
Name:KUMMERER, KAYLEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:KUMMERER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5412 MONROE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2890
Mailing Address - Country:US
Mailing Address - Phone:419-279-9576
Mailing Address - Fax:419-214-1233
Practice Address - Street 1:5412 MONROE ST STE 1
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2890
Practice Address - Country:US
Practice Address - Phone:419-279-9576
Practice Address - Fax:419-214-1233
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty