MEDICARE: KATIE ELIZABETH CLINE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT22293	FL

General Provider Information

NPI Number	:	1063882736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ELIZABETH CLINE OTR/L

Provider Business Mailing Address
First Line	:	704 SUNVIEW PL
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5915
Country	:	US
Telephone Number	:	386-627-6815
Fax Number	:

Provider Business Practice Location Address
First Line	:	2669 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8217
Country	:	US
Telephone Number	:	321-972-8326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	07/16/2025

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