Provider Demographics
NPI:1104183789
Name:CARLSON, KYLIE SUZANNE (COTA, ATC)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:SUZANNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:COTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4641
Mailing Address - Country:US
Mailing Address - Phone:703-362-8246
Mailing Address - Fax:
Practice Address - Street 1:7500 N DREAMY DRAW DR STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4641
Practice Address - Country:US
Practice Address - Phone:703-362-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7308224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant