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General NPI Number Information
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NPI Number | 1225258239
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Entity Type | Individual
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Provider Name | KELLY ANN MAUGHAN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5979 VINELAND RD 304
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City | ORLANDO
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State | FL
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Zip | 32819-7800
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Country | US
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Telephone | 407-354-3906
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Fax | 407-354-3907
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Provider Business Mailing Address
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Address Line | 2301 LAKE DEBRA DR 135
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City | ORLANDO
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State | FL
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Zip | 32835-6641
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Country | US
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Telephone | 407-405-3828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 20325
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License Number State | FL
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