Provider Demographics
NPI:1508003542
Name:QUALLS, KAYLA MARIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:QUALLS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 ARROWHEAD LN.
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521
Mailing Address - Country:US
Mailing Address - Phone:870-307-4736
Mailing Address - Fax:
Practice Address - Street 1:699 ARROWHEAD LN.
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521
Practice Address - Country:US
Practice Address - Phone:870-307-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0901225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics