Healthcare Provider Details

I. General information

NPI: 1972757656
Provider Name (Legal Business Name): KAHLILA FOWLER OTD, OTR/L,CEAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2008
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W 16TH ST
ADA OK
74820-7610
US

IV. Provider business mailing address

PO BOX 2297
ADA OK
74821-2297
US

V. Phone/Fax

Practice location:
  • Phone: 405-761-7740
  • Fax: 580-421-9491
Mailing address:
  • Phone: 405-761-7740
  • Fax: 580-421-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1433
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: