Provider Demographics
NPI:1689299778
Name:GARDNER, KAYLEE RAY (OTR)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RAY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 S KING RD
Mailing Address - Street 2:
Mailing Address - City:FLINTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37335-5310
Mailing Address - Country:US
Mailing Address - Phone:931-308-2643
Mailing Address - Fax:
Practice Address - Street 1:1360 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2332
Practice Address - Country:US
Practice Address - Phone:931-967-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist