Basic Information
| Provider Information | |||||||||
| NPI: | 1407239692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUTH | ||||||||
| FirstName: | KYLE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 DUNCAN LOOP E | ||||||||
| Address2: | APT 105 | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346981334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407049546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1980 SUNSET POINT RD | ||||||||
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| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337651132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274431588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA 14533 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.