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General NPI Number Information
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NPI Number | 1396319380
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Entity Type | Individual
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Provider Name | KAYLA MARIE PARADIS MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 840 KENNEDY MEMORIAL DR
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City | OAKLAND
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State | ME
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Zip | 04963-4887
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Country | US
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Telephone | 207-716-1863
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Fax |
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Provider Business Mailing Address
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Address Line | 128 S TAYLOR RD
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City | MOUNT VERNON
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State | ME
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Zip | 04352-3356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT4323
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License Number State | ME
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