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General NPI Number Information
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NPI Number | 1346384617
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Entity Type | Individual
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Provider Name | KATHLEEN ELLEN BANTA O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2910 SE 7TH ST
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City | OCALA
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State | FL
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Zip | 34471-2768
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Country | US
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Telephone | 352-620-2272
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Fax | 352-620-2272
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Provider Business Mailing Address
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Address Line | 2910 SE 7TH ST
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City | OCALA
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State | FL
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Zip | 34471-2768
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Country | US
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Telephone | 352-620-2272
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Fax | 352-620-2272
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT354
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License Number State | FL
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