Provider Demographics
NPI:1790400331
Name:KILCREASE, KAYLA RAE (OTD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:KILCREASE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 NE COUNTY ROAD 3020
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-5019
Mailing Address - Country:US
Mailing Address - Phone:903-467-2351
Mailing Address - Fax:
Practice Address - Street 1:440 US-59 LOOP S
Practice Address - Street 2:#104
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist