Provider Demographics
NPI:1982096616
Name:MCCORD, KAYLA BROOKE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:BROOKE
Last Name:MCCORD
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 1:1136 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3054
Mailing Address - Country:US
Mailing Address - Phone:423-335-3695
Mailing Address - Fax:
Practice Address - Street 1:406 E MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1298
Practice Address - Country:US
Practice Address - Phone:423-218-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist