Provider Demographics
NPI:1699517847
Name:KAY, DYLAN JEFFREY (LOTR)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JEFFREY
Last Name:KAY
Suffix:
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6008
Mailing Address - Country:US
Mailing Address - Phone:337-477-7883
Mailing Address - Fax:337-477-7812
Practice Address - Street 1:4750 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6008
Practice Address - Country:US
Practice Address - Phone:337-477-7883
Practice Address - Fax:337-477-7812
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338629225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist