Provider Demographics
NPI:1003368812
Name:COSGROVE, KAYLA (OT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W HORIZON RIDGE PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4395
Mailing Address - Country:US
Mailing Address - Phone:702-564-4116
Mailing Address - Fax:702-932-2403
Practice Address - Street 1:2850 W HORIZON RIDGE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4395
Practice Address - Country:US
Practice Address - Phone:702-564-4116
Practice Address - Fax:702-932-2403
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014633225X00000X
NVOT-2528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist