MEDICARE: KAYLA JEAN ABBOTT 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	225X00000X	Occupational Therapist	OT21297	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114525870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JEAN ABBOTT OTR/L

Provider Business Mailing Address
First Line	:	526 SCRUB JAY DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-1751
Country	:	US
Telephone Number	:	513-319-3910
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 PALM VALLEY RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4629
Country	:	US
Telephone Number	:	904-382-9790
Fax Number	:

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	05/11/2021

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