Healthcare Provider Details

I. General information

NPI: 1629785043
Provider Name (Legal Business Name): KYLIE MAY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 KIBLER RD
VAN BUREN AR
72956-8406
US

IV. Provider business mailing address

19299 GREENWOOD RD
SPIRO OK
74959-3847
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-2949
  • Fax:
Mailing address:
  • Phone: 480-529-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3634
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: