Provider Demographics
NPI:1164941902
Name:HICKS, KAELEIGH RENEE (MOT, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:KAELEIGH
Middle Name:RENEE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17436 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-6260
Mailing Address - Country:US
Mailing Address - Phone:813-713-0820
Mailing Address - Fax:
Practice Address - Street 1:38250 A AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5759
Practice Address - Country:US
Practice Address - Phone:813-364-5550
Practice Address - Fax:813-364-5496
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16397225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology