Provider Demographics
NPI:1689481020
Name:CRAIG, KAYLA MARY ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:MARY ELIZABETH
Last Name:CRAIG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13399 LEISURE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:DES ARC
Mailing Address - State:AR
Mailing Address - Zip Code:72040-3384
Mailing Address - Country:US
Mailing Address - Phone:501-553-4094
Mailing Address - Fax:
Practice Address - Street 1:2904 KING ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5321
Practice Address - Country:US
Practice Address - Phone:870-520-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A2074224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant