Provider Demographics
NPI:1992159362
Name:DICKSON, KAYLA (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7231
Mailing Address - Country:US
Mailing Address - Phone:580-366-8548
Mailing Address - Fax:580-366-8904
Practice Address - Street 1:611 W WABASH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7231
Practice Address - Country:US
Practice Address - Phone:580-366-8548
Practice Address - Fax:580-366-8904
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer