Individual
KENNA LYNN KACILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3128 BOXELDER DR, CHEYENNE, WY 82001-5808
(307) 634-7901
Mailing address
3982 MOUNT FLORA ST, WELLINGTON, CO 80549-2207
(570) 436-3718
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR-1208
WY
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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