Provider Demographics
NPI:1760053839
Name:MOORE, KAYLA D
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 SCOTTS LN
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9782
Mailing Address - Country:US
Mailing Address - Phone:740-630-3438
Mailing Address - Fax:
Practice Address - Street 1:6540 SCOTTS LN
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9782
Practice Address - Country:US
Practice Address - Phone:740-630-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist