Provider Demographics
NPI:1750008322
Name:SHRADER, KAYLEIGH N (LMT)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:N
Last Name:SHRADER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6529
Mailing Address - Country:US
Mailing Address - Phone:207-351-7167
Mailing Address - Fax:
Practice Address - Street 1:143 ROSS RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6529
Practice Address - Country:US
Practice Address - Phone:207-351-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist