Healthcare Provider Details

I. General information

NPI: 1679732358
Provider Name (Legal Business Name): KAYLA ZYLLA MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 1000
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR STE 1000
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4976
  • Fax:
Mailing address:
  • Phone: 320-229-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105776
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: