Provider Demographics
NPI:1972757656
Name:FOWLER, KAHLILA (OTD, OTR/L,CEAS)
Entity Type:Individual
Prefix:
First Name:KAHLILA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:OTD, OTR/L,CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2297
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-2297
Mailing Address - Country:US
Mailing Address - Phone:405-761-7740
Mailing Address - Fax:580-421-9491
Practice Address - Street 1:522 W 16TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7610
Practice Address - Country:US
Practice Address - Phone:405-761-7740
Practice Address - Fax:580-421-9491
Is Sole Proprietor?:No
Enumeration Date:2008-11-08
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1433225X00000X
225XG0600X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics