Provider Demographics
NPI:1467631382
Name:KIKUTA, KARA LEIGH (OT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEIGH
Last Name:KIKUTA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E PADONIA RD STE E
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2346
Mailing Address - Country:US
Mailing Address - Phone:410-415-1992
Mailing Address - Fax:
Practice Address - Street 1:61 E PADONIA RD STE E
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2346
Practice Address - Country:US
Practice Address - Phone:410-415-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist