Provider Demographics
NPI:1881240877
Name:FLYNN, KAYLEIGH
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 STUMPFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6812
Mailing Address - Country:US
Mailing Address - Phone:617-816-2877
Mailing Address - Fax:
Practice Address - Street 1:78 PINE ST
Practice Address - Street 2:
Practice Address - City:DIXFIELD
Practice Address - State:ME
Practice Address - Zip Code:04224-8707
Practice Address - Country:US
Practice Address - Phone:617-816-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2925225X00000X
MA13255225X00000X
MEOT3716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist