Provider Demographics
NPI:1558959940
Name:SHIELDS, KAYLA NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-3307
Mailing Address - Country:US
Mailing Address - Phone:785-410-7702
Mailing Address - Fax:
Practice Address - Street 1:5001 W 163RD TER
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-9385
Practice Address - Country:US
Practice Address - Phone:913-239-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03740225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist