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General NPI Number Information
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NPI Number | 1700280559
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Entity Type | Organization
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Legal Business Name | KG THERAPY LLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 1015 SPANISH RIVER RD #304
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City | BOCA RATON
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State | FL
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Zip | 33432-7677
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Country | US
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Telephone | 561-504-0315
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Fax | 561-533-9918
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Provider Business Mailing Address
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Address Line | 1015 SPANISH RIVER RD #304
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City | BOCA RATON
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State | FL
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Zip | 33432-7677
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Country | US
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Telephone | 561-504-0315
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Fax | 561-533-9918
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Authorized Official
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Title or Position | DIRECTOR
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Name | KASANDRA GEHRING
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Credential | OTR/L
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Telephone | 561-504-0315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | OT14978
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License Number State | FL
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