Provider Demographics
NPI:1871326165
Name:JOHNSON, KYLA AILEEN (COTA/L)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:AILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5800
Mailing Address - Country:US
Mailing Address - Phone:785-831-3053
Mailing Address - Fax:785-746-0132
Practice Address - Street 1:4911 LEGENDS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5800
Practice Address - Country:US
Practice Address - Phone:785-831-3053
Practice Address - Fax:785-746-0132
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01983224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant