Basic Information
| Provider Information | |||||||||
| NPI: | 1104153188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINES | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | NILES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALDRICH | ||||||||
| OtherFirstName: | KATE | ||||||||
| OtherMiddleName: | NILES | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Practice Location | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XL0004X | OT11688 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No ID Information.