Provider Demographics
NPI:1952962474
Name:THOMPSON, KAYLA DAVELLE (MOTR/L)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:DAVELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MRS
Other - First Name:KAYLA
Other - Middle Name:DAVELLE
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 ARNOLD PARK MALL
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010
Mailing Address - Country:US
Mailing Address - Phone:636-282-0056
Mailing Address - Fax:
Practice Address - Street 1:4 ARNOLD PARK MALL
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-282-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist