Provider Demographics
NPI:1588363949
Name:TABOR, KAYLEE S (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:S
Last Name:TABOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11347 NC 3700
Mailing Address - Street 2:
Mailing Address - City:WESTERN GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72685-7013
Mailing Address - Country:US
Mailing Address - Phone:870-754-2305
Mailing Address - Fax:
Practice Address - Street 1:916 GOBLIN DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8885
Practice Address - Country:US
Practice Address - Phone:870-204-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist