Healthcare Provider Details

I. General information

NPI: 1912102450
Provider Name (Legal Business Name): KYLA JEAN GUTHMILLER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLA JEAN PECK MS, OTR/L

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4530
US

IV. Provider business mailing address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number984
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: