Provider Demographics
NPI:1174036784
Name:FISHER, KAYLA ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1413
Mailing Address - Country:US
Mailing Address - Phone:719-250-4052
Mailing Address - Fax:
Practice Address - Street 1:2611 JONES AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2650
Practice Address - Country:US
Practice Address - Phone:719-564-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000962224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant