Provider Demographics
NPI:1033971296
Name:LANAGAN, KAYLA ROSE (OTR)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:LANAGAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 CONGRESS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2715
Mailing Address - Country:US
Mailing Address - Phone:207-699-5600
Mailing Address - Fax:207-699-5588
Practice Address - Street 1:959 CONGRESS ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2715
Practice Address - Country:US
Practice Address - Phone:207-699-5600
Practice Address - Fax:207-699-5588
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist