Provider Demographics
NPI:1679034045
Name:EVANS, KYLA ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 DELPHI FALLS RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEW WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13122-9610
Mailing Address - Country:US
Mailing Address - Phone:518-649-2440
Mailing Address - Fax:
Practice Address - Street 1:303 ROBY AVE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1800
Practice Address - Country:US
Practice Address - Phone:315-434-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist