Active NPI
Kenna Lynn Kacillas, OTR/L
- Occupational Therapist
- Cheyenne, WY
National Provider Identifier
1114447893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR-1208
- Practice address
- 3128 Boxelder Dr
Cheyenne, WY 82001-5808 - Phone
- (307) 634-7901
- NPI assigned
- Jun 22, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR-1208 | WY | Primary |
Addresses
Primary practice location
3128 Boxelder Dr
Cheyenne, WY 82001-5808
Mailing address
3982 Mount Flora St
Wellington, CO 80549-2207
Phone (570) 436-3718
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR-1208 | WY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498089600000",
"number": "1114447893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3982 MOUNT FLORA ST",
"city": "WELLINGTON",
"state": "CO",
"postal_code": "805492207",
"telephone_number": "570-436-3718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3128 BOXELDER DR",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820015808",
"telephone_number": "307-634-7901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACILLAS",
"first_name": "KENNA",
"middle_name": "LYNN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-22",
"last_updated": "2017-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WY",
"license": "OTR-1208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.