Provider Demographics
NPI:1598096372
Name:RIEGEL, KAYLA R (OTD, OTR/L, C-GCM)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:RIEGEL
Suffix:
Gender:F
Credentials:OTD, OTR/L, C-GCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 E RIVER COVE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-3553
Mailing Address - Country:US
Mailing Address - Phone:570-573-2586
Mailing Address - Fax:
Practice Address - Street 1:30070 STATE ROAD 56
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7628
Practice Address - Country:US
Practice Address - Phone:570-573-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07315225X00000X
CA22569225X00000X
PAOC010177225X00000X
FL22376225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13510734OtherCAQH