Healthcare Provider Details

I. General information

NPI: 1366110942
Provider Name (Legal Business Name): KALIE FAGINS OTD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 EVERGREEN WOODS TRL
SPRING HILL FL
34608-1306
US

IV. Provider business mailing address

922 MILANO CIR APT 102
BRANDON FL
33511-7158
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-8371
  • Fax:
Mailing address:
  • Phone: 863-221-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: