Provider Demographics
NPI:1912583105
Name:BOUSFIELD, KAYLA DEAN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DEAN
Last Name:BOUSFIELD
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 1:15 GRANDVIEW ACRES
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1038
Mailing Address - Country:US
Mailing Address - Phone:207-478-4858
Mailing Address - Fax:
Practice Address - Street 1:13659 E 104TH AVE UNIT 300
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9402
Practice Address - Country:US
Practice Address - Phone:720-506-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15369-24225100000X
VT040-0134255225100000X
MD28700225100000X
COPTL.0018606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist