Provider Demographics
NPI:1245502590
Name:PARSONS, KAYLA A (CMT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:PARSONS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 OLD ATHENS ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-8927
Mailing Address - Country:US
Mailing Address - Phone:304-308-3016
Mailing Address - Fax:
Practice Address - Street 1:2716 OLD ATHENS ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-8927
Practice Address - Country:US
Practice Address - Phone:304-308-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20092622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2009-2622OtherSTATE LICENSE
WV579573-09OtherNATIONAL CERTIFICATION NCBTMB