Provider Demographics
NPI:1700400504
Name:HAINES, KYLI LEAH (MA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KYLI
Middle Name:LEAH
Last Name:HAINES
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 FLETCHER AVE APT 275
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1045
Mailing Address - Country:US
Mailing Address - Phone:308-293-0640
Mailing Address - Fax:
Practice Address - Street 1:800 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1500
Practice Address - Country:US
Practice Address - Phone:402-643-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer