Kayla Marie Camburn

Individual provider Active NPI Developmental Therapist · Morton Grove, IL

NPI 1962993980 · NPPES record last updated Jun 16, 2018

Key facts

NPI
1962993980
Entity type
Individual (NPI type 1)
Primary specialty
Developmental Therapist 222Q00000X
Practice address
8613 Fernald Ave
Morton Grove, IL 60053-2822
Phone
(630) 787-0482
Fax
(630) 787-0484
NPI assigned
May 24, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X Yes

Addresses

Primary practice location

8613 Fernald Ave
Morton Grove, IL 60053-2822

Mailing address

8613 Fernald Ave
Morton Grove, IL 60053-2822
Phone (630) 787-0482

Other providers in Morton Grove, IL

All providers in Morton Grove, IL · Developmental Therapist in Illinois

Sources for this page

Verify at the official NPI Registry.