Provider Demographics
NPI:1013459635
Name:KLEIHAUER, KAYLA (MED, LAT, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KLEIHAUER
Suffix:
Gender:F
Credentials:MED, LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5921 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1746
Practice Address - Country:US
Practice Address - Phone:515-953-0024
Practice Address - Fax:515-953-0257
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0009452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2000006151OtherCERTIFIED ATHLETIC TRAINER
IA000945OtherLICENSED ATHLETIC TRAINER
IAB-11-350-21OtherEMERGENCY MEDICAL TECHNICIAN