Provider Demographics
NPI:1407247562
Name:EBBERT, KAYLA
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:
Last Name:EBBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ROLLING DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1029
Mailing Address - Country:US
Mailing Address - Phone:412-973-6755
Mailing Address - Fax:
Practice Address - Street 1:2589 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3510
Practice Address - Country:US
Practice Address - Phone:412-372-3682
Practice Address - Fax:412-372-3801
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008089224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant