Healthcare Provider Details

I. General information

NPI: 1801394135
Provider Name (Legal Business Name): KYRA CAUDILL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

3863 BELLEAU WOOD DR APT 5
LEXINGTON KY
40517-1851
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-5445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number246993
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: