Provider Demographics
NPI:1144774761
Name:BERNAL, KAYLA (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 CINNAMON FERN LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4924
Mailing Address - Country:US
Mailing Address - Phone:786-246-2403
Mailing Address - Fax:
Practice Address - Street 1:3802 CINNAMON FERN LOOP
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-4924
Practice Address - Country:US
Practice Address - Phone:786-246-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15239224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant