Provider Demographics
NPI:1770125312
Name:BUCK, KAYLA VANESSA (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:VANESSA
Last Name:BUCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 NUMBER 5 SCHOOL RD NW
Mailing Address - Street 2:
Mailing Address - City:ASH
Mailing Address - State:NC
Mailing Address - Zip Code:28420-2122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 NUMBER 5 SCHOOL RD NW
Practice Address - Street 2:
Practice Address - City:ASH
Practice Address - State:NC
Practice Address - Zip Code:28420-2122
Practice Address - Country:US
Practice Address - Phone:910-287-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist