Provider Demographics
NPI:1174785943
Name:TATE, KACY YVETTE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KACY
Middle Name:YVETTE
Last Name:TATE
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 1:1173 RIVERSIDE TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1735
Mailing Address - Country:US
Mailing Address - Phone:770-536-9573
Mailing Address - Fax:
Practice Address - Street 1:1311 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1128
Practice Address - Country:US
Practice Address - Phone:352-376-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13155225X00000X
GAOT003586225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist