Healthcare Provider Details

I. General information

NPI: 1215250618
Provider Name (Legal Business Name): KATHLEEN M. VIGELAND M.S., T.V.I, IT DS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN M. GOLZ M.S., TVI, ITDS

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 FOURTH ST N
ST PETERSBURG FL
33704-1337
US

IV. Provider business mailing address

P.O. BOX 136
BRADENTON FL
34206-0136
US

V. Phone/Fax

Practice location:
  • Phone: 941-545-2323
  • Fax:
Mailing address:
  • Phone: 941-545-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: