Provider Demographics
NPI:1558614685
Name:GESKE, KAYLA JO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:JO
Last Name:GESKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 TOM AUSTIN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172
Mailing Address - Country:US
Mailing Address - Phone:615-382-7979
Mailing Address - Fax:615-382-7909
Practice Address - Street 1:3131 TOM AUSTIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-382-7979
Practice Address - Fax:615-382-7909
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist