Provider Demographics
NPI:1922465483
Name:FYLAK, KRISTA MARIA (MA, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIA
Last Name:FYLAK
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MARIA
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:381 SANTA ROSA BLVD UNIT C708
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-3112
Mailing Address - Country:US
Mailing Address - Phone:937-272-3490
Mailing Address - Fax:
Practice Address - Street 1:381 SANTA ROSA BLVD UNIT C708
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-3112
Practice Address - Country:US
Practice Address - Phone:937-272-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist