Provider Demographics
NPI:1215326277
Name:INGERSON, KAYLA (OT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:INGERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:11193 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5735
Mailing Address - Country:US
Mailing Address - Phone:207-299-4199
Mailing Address - Fax:
Practice Address - Street 1:4122 TERRY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4597
Practice Address - Country:US
Practice Address - Phone:757-638-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004288225X00000X
VA0119006640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist