Provider Demographics
NPI:1780263608
Name:CISSELL, KAYLA ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ANN
Last Name:CISSELL
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 1:1456 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2308
Mailing Address - Country:US
Mailing Address - Phone:502-827-3792
Mailing Address - Fax:
Practice Address - Street 1:1505 S DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1480
Practice Address - Country:US
Practice Address - Phone:270-786-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist