Healthcare Provider Details

I. General information

NPI: 1790694362
Provider Name (Legal Business Name): KAYLYN ALYSSA CALHOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4614
US

IV. Provider business mailing address

5809 160TH AVE E UNIT F1
SUMNER WA
98390-3175
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.OC.61478828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: