Provider Demographics
NPI:1972084143
Name:STANLEY, KAYLA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:STANLEY
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 1:14333 TEXAS HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75560-4606
Mailing Address - Country:US
Mailing Address - Phone:903-799-0883
Mailing Address - Fax:
Practice Address - Street 1:1104 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3246
Practice Address - Country:US
Practice Address - Phone:870-949-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213054OtherCOTA LICENSE