Provider Demographics
NPI:1679991772
Name:HOLSTON, KAYLAN KIRKLAND (MSOTR/L)
Entity type:Individual
Prefix:MISS
First Name:KAYLAN
Middle Name:KIRKLAND
Last Name:HOLSTON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 50TH ST
Mailing Address - Street 2:APARTMENT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-7930
Mailing Address - Country:US
Mailing Address - Phone:404-403-2459
Mailing Address - Fax:
Practice Address - Street 1:360 E 50TH ST
Practice Address - Street 2:APARTMENT 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7930
Practice Address - Country:US
Practice Address - Phone:404-403-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist