Provider Demographics
NPI:1780006601
Name:KAYLA, JOANNA (COTA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KAYLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 121ST ST SE
Mailing Address - Street 2:L103
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5999
Mailing Address - Country:US
Mailing Address - Phone:425-773-1653
Mailing Address - Fax:206-694-2290
Practice Address - Street 1:1600 121ST ST SE
Practice Address - Street 2:L103
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5999
Practice Address - Country:US
Practice Address - Phone:425-773-1653
Practice Address - Fax:206-694-2290
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 00000811171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor