Individual
KAYLA N HEISEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
274 W NATIONAL RD APT 5, VANDALIA, OH 45377-1946
(937) 203-6557
Mailing address
274 W NATIONAL RD APT 5, VANDALIA, OH 45377-1946
(937) 203-6557
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5505101
—
OH
Enumeration date
11/16/2020
Last updated
11/16/2020
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