MEDICARE: DR. KYLIE KATHRYN ALLAN OTD, OTR/L

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	26915	CA

General Provider Information

NPI Number	:	1770309288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLIE KATHRYN ALLAN OTD, OTR/L

Provider Business Mailing Address
First Line	:	13223 BLACK MOUNTAIN RD # 1508
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	760-215-5531
Fax Number	:

Provider Business Practice Location Address
First Line	:	13223 BLACK MOUNTAIN RD # 1508
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	760-215-5531
Fax Number	:

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

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	03/26/2026

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