Provider Demographics
NPI:1497220891
Name:NICHOLSON, KAYLA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NICHOLSON
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 1:731 BLANKENSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7512
Mailing Address - Country:US
Mailing Address - Phone:949-327-1713
Mailing Address - Fax:
Practice Address - Street 1:2641 HAMNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3637
Practice Address - Country:US
Practice Address - Phone:626-536-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist