Provider Demographics
NPI:1376241794
Name:CLARE, KAYLA GABRIELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:GABRIELLE
Last Name:CLARE
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 1:217 SHADOWS LAWN DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3951
Mailing Address - Country:US
Mailing Address - Phone:423-368-8842
Mailing Address - Fax:
Practice Address - Street 1:217 SHADOWS LAWN DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3951
Practice Address - Country:US
Practice Address - Phone:423-368-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5400OtherTENNESSEE STATE BOARD OF OCCUPATIONAL THERAPY