Provider Demographics
NPI:1255141719
Name:BENJAMIN, KAYLA JO (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JO
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 253RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7134
Mailing Address - Country:US
Mailing Address - Phone:641-485-7853
Mailing Address - Fax:
Practice Address - Street 1:LAKES REGIONAL HEALTHCARE
Practice Address - Street 2:2301 HWY 71 S
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:641-336-8651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist