Provider Demographics
NPI:1003428277
Name:WILKINS, KYLIE ROSE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:KYLIE
Middle Name:ROSE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2936
Mailing Address - Country:US
Mailing Address - Phone:716-880-0155
Mailing Address - Fax:
Practice Address - Street 1:5285 LEWISTON RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1942
Practice Address - Country:US
Practice Address - Phone:716-298-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010614224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant