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General NPI Number Information
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NPI Number | 1508474511
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Entity Type | Individual
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Provider Name | KAILEY WORTHINGTON
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Gender | Female
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 1701 68TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-8744
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Country | US
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Telephone | 727-828-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 260 1ST AVE S STE 200
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4364
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT20529
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License Number State | FL
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