Provider Demographics
NPI:1225300643
Name:PLUTSCHACK, KAYLA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PLUTSCHACK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 SEEKONK AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8937
Mailing Address - Country:US
Mailing Address - Phone:309-945-5627
Mailing Address - Fax:
Practice Address - Street 1:134 PARK CENTRAL SQ
Practice Address - Street 2:#220
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1339
Practice Address - Country:US
Practice Address - Phone:844-536-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001291225X00000X
FL15054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist