Provider Demographics
NPI:1518573260
Name:LANGE, KAILA ANN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:ANN
Last Name:LANGE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:ANN
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:136 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1026
Mailing Address - Country:US
Mailing Address - Phone:309-558-5087
Mailing Address - Fax:
Practice Address - Street 1:4450 48TH ST CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61202
Practice Address - Country:US
Practice Address - Phone:309-558-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist