Healthcare Provider Details

I. General information

NPI: 1548885957
Provider Name (Legal Business Name): KAILEY HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S SEMORAN BLVD STE 110
WINTER PARK FL
32792-5313
US

IV. Provider business mailing address

1773 ARBORWOOD DR
FLORENCE KY
41042-2598
US

V. Phone/Fax

Practice location:
  • Phone: 407-961-6834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number144327
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: