Provider Demographics
NPI:1164989497
Name:NICHOLS, KAYLA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 OAK ALLEY DR S
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-4489
Mailing Address - Country:US
Mailing Address - Phone:251-517-0355
Mailing Address - Fax:
Practice Address - Street 1:8909 RAND AVE STE C
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9126
Practice Address - Country:US
Practice Address - Phone:251-210-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty