Provider Demographics
NPI:1558791756
Name:BOYER, KAILA (ATC)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CORSONS TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1069
Mailing Address - Country:US
Mailing Address - Phone:609-576-9549
Mailing Address - Fax:
Practice Address - Street 1:516 CORSONS TAVERN RD
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1069
Practice Address - Country:US
Practice Address - Phone:609-576-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001639002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer