Provider Demographics
NPI:1851826218
Name:JILEK, KAYLA JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JO
Last Name:JILEK
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 1:448 21ST ST W
Mailing Address - Street 2:STE D1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2647
Mailing Address - Country:US
Mailing Address - Phone:701-483-1000
Mailing Address - Fax:
Practice Address - Street 1:448 21ST ST W
Practice Address - Street 2:STE D1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2647
Practice Address - Country:US
Practice Address - Phone:701-483-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist