Provider Demographics
NPI:1861066359
Name:STEFFEN, KYLA JO
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:JO
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13969 E 2100TH AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-6897
Mailing Address - Country:US
Mailing Address - Phone:217-276-9147
Mailing Address - Fax:
Practice Address - Street 1:201 LAFAYETTE AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4641
Practice Address - Country:US
Practice Address - Phone:217-235-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005229225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant