Provider Demographics
NPI:1033668132
Name:WILLIAMS, KAYLA SUE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:SUE
Other - Last Name:HOFFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:106 S HOLMEN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9467
Mailing Address - Country:US
Mailing Address - Phone:608-526-9888
Mailing Address - Fax:
Practice Address - Street 1:3501 PARK LANE DR
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7747
Practice Address - Country:US
Practice Address - Phone:608-789-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4731-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant