Healthcare Provider Details

I. General information

NPI: 1033039854
Provider Name (Legal Business Name): KYLA BRANDT OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 SPRINGVIEW RD
POCAHONTAS AR
72455-4931
US

IV. Provider business mailing address

2127 SPRINGVIEW RD
POCAHONTAS AR
72455-4931
US

V. Phone/Fax

Practice location:
  • Phone: 870-758-2065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2184
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: