Healthcare Provider Details

I. General information

NPI: 1083336747
Provider Name (Legal Business Name): KATE BIRMINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SUMMIT BLVD # 240
PENSACOLA FL
32503-3357
US

IV. Provider business mailing address

3510 SILVERTREE LN
PENSACOLA FL
32504-4911
US

V. Phone/Fax

Practice location:
  • Phone: 850-746-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT23097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: