Healthcare Provider Details

I. General information

NPI: 1629421391
Provider Name (Legal Business Name): KASCEL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WATKINS PL
PALM COAST FL
32164-7643
US

IV. Provider business mailing address

10 WATKINS PL
PALM COAST FL
32164-7643
US

V. Phone/Fax

Practice location:
  • Phone: 386-585-5955
  • Fax:
Mailing address:
  • Phone: 386-585-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberL16000012825
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberOT14766
License Number StateFL

VIII. Authorized Official

Name: JENNIFER MICHELLE BAKER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 386-585-5955