Healthcare Provider Details

I. General information

NPI: 1851922231
Provider Name (Legal Business Name): KAYLA NICOLE PARKER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA NICOLE MULLEN MS, OTR/L

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11091 N RADIO STATION RD
SENECA SC
29678-1142
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 864-654-2001
  • Fax:
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8013
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007637
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: