Healthcare Provider Details

I. General information

NPI: 1942599923
Provider Name (Legal Business Name): KAILEY SUZANNE CROSSLIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 BAILLIE DR
NEW PORT RICHEY FL
34653-4914
US

IV. Provider business mailing address

9706 W PARK VILLAGE DR
TAMPA FL
33626-5137
US

V. Phone/Fax

Practice location:
  • Phone: 630-390-4321
  • Fax:
Mailing address:
  • Phone: 630-390-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0.56.008929
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: