Provider Demographics
NPI:1881077295
Name:SCHNEIDER, KAYLA B (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:B
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:B
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 E ENTERPRISE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-991-2561
Mailing Address - Fax:
Practice Address - Street 1:2105 E ENTERPRISE AVE STE 113
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7862
Practice Address - Country:US
Practice Address - Phone:920-991-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1460-39174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist