Provider Demographics
NPI:1225406267
Name:IRWIN, KALEA (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:KALEA
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 BREMOND DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4014
Mailing Address - Country:US
Mailing Address - Phone:806-382-6845
Mailing Address - Fax:
Practice Address - Street 1:1250 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1741
Practice Address - Country:US
Practice Address - Phone:806-353-3596
Practice Address - Fax:806-353-4927
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212162224Z00000X
TX121126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121126OtherECPTOTE