Provider Demographics
NPI:1144880527
Name:TOLSTYKA, KAYLA MARIE (CTRS)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:TOLSTYKA
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:SMOGOLESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:1404 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5531
Mailing Address - Country:US
Mailing Address - Phone:231-690-9692
Mailing Address - Fax:
Practice Address - Street 1:1404 PARK AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5531
Practice Address - Country:US
Practice Address - Phone:231-690-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI59689225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist