Provider Demographics
NPI:1093194557
Name:VARGAS, KAITLYN (MOT, OTR/L, SLPA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MOT, OTR/L, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 NW 36TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6974
Mailing Address - Country:US
Mailing Address - Phone:305-526-2426
Mailing Address - Fax:
Practice Address - Street 1:3400 CORAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3053
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23161225X00000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114308600Medicaid