Provider Demographics
NPI:1609441104
Name:HULL, KAYLEE MAE (MAT, AT, ATC)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MAE
Last Name:HULL
Suffix:
Gender:F
Credentials:MAT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MAUMEE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9330
Mailing Address - Country:US
Mailing Address - Phone:419-450-2171
Mailing Address - Fax:
Practice Address - Street 1:8700 MAUMEE WESTERN RD
Practice Address - Street 2:
Practice Address - City:MONCLOVA
Practice Address - State:OH
Practice Address - Zip Code:43542-9330
Practice Address - Country:US
Practice Address - Phone:419-450-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0068072255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer