Provider Demographics
NPI:1861131666
Name:DUCKETT-MOORE, KAYLA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:DUCKETT-MOORE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-4502
Mailing Address - Country:US
Mailing Address - Phone:828-649-5016
Mailing Address - Fax:828-201-2335
Practice Address - Street 1:3 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-4502
Practice Address - Country:US
Practice Address - Phone:828-649-5016
Practice Address - Fax:828-201-2335
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist