Kayla Michelle Fomin, OMT

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

136 Homeplace Dr
Mt Holly, NC 28120-9660

Phone

(803) 820-1607

NPI assigned

Aug 24, 2022

Last updated

Aug 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Kayla Zauber Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1407575335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 HOMEPLACE DR",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281209660",
            "telephone_number": "803-820-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 HOMEPLACE DR",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281209660",
            "telephone_number": "803-820-1607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMIN",
        "first_name": "KAYLA",
        "middle_name": "MICHELLE",
        "credential": "OMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NC",
            "license": "11570",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://kayla-fomin.clientsecure.me",
            "affiliation": "N",
            "endpointDescription": "Client Portal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "136 Homeplace Dr",
            "city": "MT Holly",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281209660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "ZAUBER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Specialist in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.