Provider Demographics
NPI:1932974516
Name:FICK, KYLIE CELESTE (COTA)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:CELESTE
Last Name:FICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:CELESTE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 EAGLE WATCH RD
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5381
Mailing Address - Country:US
Mailing Address - Phone:563-261-6751
Mailing Address - Fax:
Practice Address - Street 1:128 BRAWLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9102
Practice Address - Country:US
Practice Address - Phone:704-799-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant