Basic Information
| Provider Information | |||||||||
| NPI: | 1588155592 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KUSE | ||||||||
| FirstName: | AYANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 273 LANCER OAK DR | ||||||||
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| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327122758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075355429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 W BROADWAY ST STE 214 | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327659262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073595693 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA15963 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.