Healthcare Provider Details

I. General information

NPI: 1104754886
Provider Name (Legal Business Name): KATHRYN MARY EGGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SAND LAKE RD
ORLANDO FL
32809-7750
US

IV. Provider business mailing address

2334 CONWAY RD APT D
ORLANDO FL
32812-8302
US

V. Phone/Fax

Practice location:
  • Phone: 407-412-6114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1571364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: