Provider Demographics
NPI:1538775507
Name:RUPPE, KAYLA RENEA (OTA/L)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEA
Last Name:RUPPE
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ELLIS BINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37829-2816
Mailing Address - Country:US
Mailing Address - Phone:423-215-5858
Mailing Address - Fax:
Practice Address - Street 1:116 CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887
Practice Address - Country:US
Practice Address - Phone:423-215-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001748224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant