Basic Information
| Provider Information | |||||||||
| NPI: | 1659004208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUETZLOE | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 TWISTED BRANCH LN | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347718915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158777324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 BUDINGER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347697203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
| FaxNumber: | 8884778981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2022 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 23155 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 23155 | 01 | FL | STATE LICENSE | OTHER |