Provider Demographics
NPI:1417589045
Name:WOOD, KYLIE (OTR)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SHOAL CREEK BLVD STE 110W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1041
Mailing Address - Country:US
Mailing Address - Phone:512-610-1190
Mailing Address - Fax:512-610-1191
Practice Address - Street 1:7800 SHOAL CREEK BLVD STE 110W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1041
Practice Address - Country:US
Practice Address - Phone:512-610-1190
Practice Address - Fax:512-610-1191
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120233OtherOTR LICENSE