Provider Demographics
NPI:1386369353
Name:WAARANIEMI, KAYLA (COTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:WAARANIEMI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 ELM AVE SE
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-3153
Mailing Address - Country:US
Mailing Address - Phone:307-710-1954
Mailing Address - Fax:
Practice Address - Street 1:505 W NORTHERN LIGHTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2552
Practice Address - Country:US
Practice Address - Phone:907-205-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200528224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant