Provider Demographics
NPI:1477815470
Name:KELLEY, KAYLA (OTR)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KELLEY
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 1:202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-4349
Mailing Address - Country:US
Mailing Address - Phone:254-393-0081
Mailing Address - Fax:254-393-0205
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NOLANVILLE
Practice Address - State:TX
Practice Address - Zip Code:76559-4349
Practice Address - Country:US
Practice Address - Phone:254-393-0081
Practice Address - Fax:254-393-0205
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114857225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics