Provider Demographics
NPI:1023603933
Name:BARBER, KAILEY MARIAH (OTR/L)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:MARIAH
Last Name:BARBER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 KINGDOM AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7587
Mailing Address - Country:US
Mailing Address - Phone:321-576-6025
Mailing Address - Fax:
Practice Address - Street 1:2811 KINGDOM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7587
Practice Address - Country:US
Practice Address - Phone:321-576-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21675225X00000X
FLOT21675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist