Healthcare Provider Details

I. General information

NPI: 1306564240
Provider Name (Legal Business Name): KYLA MARIE CHASE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14560 LAKESIDE CIR
STERLING HEIGHTS MI
48313-1350
US

IV. Provider business mailing address

31690 W 12 MILE RD
FARMINGTON HILLS MI
48334-4404
US

V. Phone/Fax

Practice location:
  • Phone: 586-247-3220
  • Fax:
Mailing address:
  • Phone: 248-328-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: