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General NPI Number Information
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NPI Number | 1780263608
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Entity Type | Individual
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Provider Name | KAYLA ANN CISSELL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 1505 S DIXIE ST
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City | HORSE CAVE
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State | KY
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Zip | 42749-1480
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Country | US
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Telephone | 270-786-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1456 NEW HAVEN RD
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City | BARDSTOWN
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State | KY
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Zip | 40004-2308
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Country | US
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Telephone | 502-827-3792
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 268528
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License Number State | KY
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