Healthcare Provider Details

I. General information

NPI: 1235647595
Provider Name (Legal Business Name): CAILY DANIELLE O'CONNOR LRT/CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1661
  • Fax:
Mailing address:
  • Phone: 523-226-3248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: