Provider Demographics
NPI:1245642438
Name:O'MALLEY, KAYLA (DPM)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1834
Mailing Address - Country:US
Mailing Address - Phone:413-525-5200
Mailing Address - Fax:413-525-5700
Practice Address - Street 1:250 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1834
Practice Address - Country:US
Practice Address - Phone:413-525-5200
Practice Address - Fax:413-525-5700
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2454213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110126008AMedicaid