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General NPI Number Information
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NPI Number | 1629421391
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Entity Type | Organization
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Legal Business Name | KASCEL THERAPY, LLC
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 10 WATKINS PL
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City | PALM COAST
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State | FL
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Zip | 32164-7643
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Country | US
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Telephone | 386-585-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 10 WATKINS PL
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City | PALM COAST
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State | FL
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Zip | 32164-7643
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Country | US
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Telephone | 386-585-5955
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JENNIFER MICHELLE BAKER
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Credential | OTD, OTR/L
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Telephone | 386-585-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | OT14766
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | L16000012825
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License Number State | FL
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