Provider Demographics
NPI:1669937249
Name:RYLKO, SOPHIA JULIET (OTR/L)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:JULIET
Last Name:RYLKO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 W 21ST TER
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-2715
Mailing Address - Country:US
Mailing Address - Phone:785-393-9894
Mailing Address - Fax:
Practice Address - Street 1:5015 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2319
Practice Address - Country:US
Practice Address - Phone:785-273-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist