Provider Demographics
NPI:1023527884
Name:CLOVIS, KYLAH (OT)
Entity type:Individual
Prefix:
First Name:KYLAH
Middle Name:
Last Name:CLOVIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KYLAH
Other - Middle Name:
Other - Last Name:CAUTHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5110 S YALE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7438
Mailing Address - Country:US
Mailing Address - Phone:918-492-2386
Mailing Address - Fax:918-645-8686
Practice Address - Street 1:5110 S YALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7438
Practice Address - Country:US
Practice Address - Phone:918-492-2386
Practice Address - Fax:918-645-8686
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2149225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty