Provider Demographics
NPI:1457159873
Name:MATTERA, KAILA (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:KAILA
Middle Name:
Last Name:MATTERA
Suffix:
Gender:
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W 20TH ST APT J300
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8493
Mailing Address - Country:US
Mailing Address - Phone:805-336-6770
Mailing Address - Fax:
Practice Address - Street 1:1025 9TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4039
Practice Address - Country:US
Practice Address - Phone:805-336-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist