Provider Demographics
NPI:1821301169
Name:WENKER, KAYLA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:WENKER
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 1:1723 SW LAKE ROESIGER RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7557
Mailing Address - Country:US
Mailing Address - Phone:218-639-0952
Mailing Address - Fax:
Practice Address - Street 1:200 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2336
Practice Address - Country:US
Practice Address - Phone:360-804-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60299131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist