MEDICARE: KAYLA CHISM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	24109	CA

General Provider Information

NPI Number	:	1003507120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA CHISM

Provider Business Mailing Address
First Line	:	369 S DOHENY DR # 511
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 S DOHENY DR # 511
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3508
Country	:	US
Telephone Number	:	909-278-3182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	10/01/2025

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Directions to “ KAYLA CHISM ” Practice Location

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