MEDICARE: KAYLI ELAINE CHILDERS OTR, OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	125643	TX

General Provider Information

NPI Number	:	1568352938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLI ELAINE CHILDERS OTR, OTD

Provider Business Mailing Address
First Line	:	16175 ADDISON RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3252
Country	:	US
Telephone Number	:	817-479-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	16175 ADDISON RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3252
Country	:	US
Telephone Number	:	817-479-7019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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