=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710697875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA BLOUNT COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2022
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 585 OH-741
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-398-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 FURBEE DR S
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-678-9857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA.06057
-----------------------------------------------------
License Number State |
-----------------------------------------------------