Provider Demographics
NPI:1013371137
Name:FORD, KAYLA (OTR)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3230 RUE CHANEL
Mailing Address - Street 2:APT 162
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6669
Mailing Address - Country:US
Mailing Address - Phone:812-569-2628
Mailing Address - Fax:
Practice Address - Street 1:3230 RUE CHANEL
Practice Address - Street 2:APT 162
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:812-569-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006039A225X00000X
IN99069334A247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other