Provider Demographics
NPI:1134873904
Name:KAIA REHAB & WELLNESS LLC
Entity type:Organization
Organization Name:KAIA REHAB & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIMILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:770-807-4503
Mailing Address - Street 1:5805 STATE BRIDGE RD
Mailing Address - Street 2:STE G, #224
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-807-4503
Mailing Address - Fax:470-517-7334
Practice Address - Street 1:1321 SUGARLOAF RESERVE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4054
Practice Address - Country:US
Practice Address - Phone:770-807-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty