Healthcare Provider Details

I. General information

NPI: 1922930775
Provider Name (Legal Business Name): KALEB DOUGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1609 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-584-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: