Provider Demographics
NPI:1417483744
Name:MUCKENHIRN, KAYLA JOY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOY
Last Name:MUCKENHIRN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1367 WILLOW ST
Mailing Address - Street 2:APT. 236
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2492
Mailing Address - Country:US
Mailing Address - Phone:320-815-8043
Mailing Address - Fax:
Practice Address - Street 1:3525 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5275
Practice Address - Country:US
Practice Address - Phone:952-993-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105357225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health