Provider Demographics
NPI:1780031013
Name:HUSTON, KAILEE
Entity Type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:HUSTON
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 1:224 MAIN ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3192
Mailing Address - Country:US
Mailing Address - Phone:603-893-8550
Mailing Address - Fax:
Practice Address - Street 1:3 INDUSTRIAL DR
Practice Address - Street 2:UNIT 1
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2014
Practice Address - Country:US
Practice Address - Phone:603-870-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2544225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics