Provider Demographics
NPI:1497926067
Name:THIBAULT, KYLA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:
Last Name:THIBAULT
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 1:181 CORLISS LN
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3207
Mailing Address - Country:US
Mailing Address - Phone:603-388-4206
Mailing Address - Fax:603-237-6039
Practice Address - Street 1:181 CORLISS LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3207
Practice Address - Country:US
Practice Address - Phone:603-388-4206
Practice Address - Fax:603-237-6039
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000165225X00000X
NH0995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist