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General NPI Number Information
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NPI Number | 1295609063
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Entity Type | Individual
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Provider Name | KAITLYN MARKOVICH
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Gender |
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 631 SW ASTER RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2906
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Country | US
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Telephone | 412-897-7567
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Fax |
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Provider Business Mailing Address
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Address Line | 631 SW ASTER RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2906
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA17745
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License Number State | FL
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