Provider Demographics
NPI:1053971788
Name:HOUSE, KYLEE JOANNE (COTA)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:JOANNE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:JOANNE
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7712 COUNTY ROAD 1200
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-4050
Mailing Address - Country:US
Mailing Address - Phone:817-648-8223
Mailing Address - Fax:
Practice Address - Street 1:7712 COUNTY ROAD 1200
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-4050
Practice Address - Country:US
Practice Address - Phone:817-648-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214199224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant