Basic Information
| Provider Information | |||||||||
| NPI: | 1831178904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHECKLER | ||||||||
| FirstName: | KALA | ||||||||
| MiddleName: | HOPE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8226 REGENTS CT | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342012235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413550098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 1381 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | Z100D | 01 | BLUE CROSS BLUE SHIELD FL | OTHER |