Healthcare Provider Details

I. General information

NPI: 1427612225
Provider Name (Legal Business Name): KAITLYN BOSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 CORTEZ BLVD
SPRING HILL FL
34613-5578
US

IV. Provider business mailing address

4433 MARCHMONT BLVD
LAND O LAKES FL
34638-7760
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5100
  • Fax:
Mailing address:
  • Phone: 352-442-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: