Provider Demographics
NPI:1619338548
Name:LANGEN, KAYLA (ATC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LANGEN
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 1:3510 COUNTRYDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6520
Mailing Address - Country:US
Mailing Address - Phone:859-394-8625
Mailing Address - Fax:
Practice Address - Street 1:531 E TULLY ST
Practice Address - Street 2:
Practice Address - City:CONVOY
Practice Address - State:OH
Practice Address - Zip Code:45832-8864
Practice Address - Country:US
Practice Address - Phone:419-749-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer