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General NPI Number Information
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NPI Number | 1710557863
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Entity Type | Individual
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Provider Name | KYLA DRAKE
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Gender | Female
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 3940 US HIGHWAY 54
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City | MORAN
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State | KS
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Zip | 66755-3921
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Country | US
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Telephone | 620-473-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 623 N 4TH ST
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City | IOLA
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State | KS
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Zip | 66749-2523
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-03575
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License Number State | KS
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