Provider Demographics
NPI:1356174577
Name:MARLEY, KAYEN
Entity type:Individual
Prefix:
First Name:KAYEN
Middle Name:
Last Name:MARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WALNUT RIDGE ST APT 308
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-6500
Mailing Address - Country:US
Mailing Address - Phone:775-304-3823
Mailing Address - Fax:
Practice Address - Street 1:705 WALNUT RIDGE ST APT 308
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-6500
Practice Address - Country:US
Practice Address - Phone:775-304-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024026345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist