Provider Demographics
NPI:1881970267
Name:FELL, KAYLA LACHELE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LACHELE
Last Name:FELL
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:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-0322
Mailing Address - Country:US
Mailing Address - Phone:717-965-6389
Mailing Address - Fax:
Practice Address - Street 1:1000 W ELM ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3417
Practice Address - Country:US
Practice Address - Phone:717-965-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health