Provider Demographics
NPI:1215519194
Name:CONNOR, KAYLA M (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:M
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:M
Other - Last Name:JACKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:1028 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1317
Mailing Address - Country:US
Mailing Address - Phone:815-545-5615
Mailing Address - Fax:
Practice Address - Street 1:5835 E NORTH PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-7308
Practice Address - Country:US
Practice Address - Phone:815-390-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist