Healthcare Provider Details

I. General information

NPI: 1023986700
Provider Name (Legal Business Name): KAITLYN ASHLEY ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 SANDLAKE COMMONS BLVD
ORLANDO FL
32819-8033
US

IV. Provider business mailing address

12 CASCADE RD
COLUMBUS GA
31904-2807
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7869
  • Fax:
Mailing address:
  • Phone: 714-944-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: