Provider Demographics
NPI:1114106382
Name:BACH, KAYLA BRIE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:BRIE
Last Name:BACH
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:BRIE
Other - Last Name:MOERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37160 DICKERSON RUN
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-8403
Mailing Address - Country:US
Mailing Address - Phone:970-690-6696
Mailing Address - Fax:970-449-0525
Practice Address - Street 1:37160 DICKERSON RUN
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-8403
Practice Address - Country:US
Practice Address - Phone:970-690-6696
Practice Address - Fax:970-449-0525
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist