=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720433188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA TORRENCE MOT, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 08/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8561 MARKET ST
-----------------------------------------------------
City | BOARDMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-6727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-953-2383
-----------------------------------------------------
Fax | 330-953-2384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1043 HARBOUR LIGHTS BLVD
-----------------------------------------------------
City | COLUMBIANA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44408-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-714-4998
-----------------------------------------------------
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 | OP008121
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC017398
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------