Provider Demographics
NPI:1689833832
Name:HILL, KYLA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:MARIE
Last Name:HILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 STANNUS ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7067
Mailing Address - Country:US
Mailing Address - Phone:501-447-7200
Mailing Address - Fax:501-447-7201
Practice Address - Street 1:4015 STANNUS ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7067
Practice Address - Country:US
Practice Address - Phone:501-447-7200
Practice Address - Fax:501-447-7201
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251300000X225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116837743Medicaid