Provider Demographics
NPI:1992218275
Name:PROCHASKA, KAY LYNNE (OT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LYNNE
Last Name:PROCHASKA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DAISY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124
Mailing Address - Country:US
Mailing Address - Phone:979-541-3480
Mailing Address - Fax:
Practice Address - Street 1:12413 JUDSON RD STE 260
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3262
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:210-656-7957
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist