Provider Demographics
NPI:1417483744
Name:MUCKENHIRN, KAYLA JOY (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOY
Last Name:MUCKENHIRN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:639 STRUCK STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1383
Mailing Address - Country:US
Mailing Address - Phone:608-234-5990
Mailing Address - Fax:608-819-6825
Practice Address - Street 1:639 STRUCK STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1383
Practice Address - Country:US
Practice Address - Phone:608-234-5990
Practice Address - Fax:608-819-6825
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6545-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist