Provider Demographics
NPI:1497095319
Name:WOLFE, KAYLA RAE (COTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:WI
Mailing Address - Zip Code:54421-9618
Mailing Address - Country:US
Mailing Address - Phone:715-650-2008
Mailing Address - Fax:
Practice Address - Street 1:7517 W COLDSPRING RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-2814
Practice Address - Country:US
Practice Address - Phone:414-327-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4888-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant