Provider Demographics
NPI:1376238402
Name:WOOD, KADIE MICHELLE
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:MICHELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 SE 39TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-0636
Mailing Address - Country:US
Mailing Address - Phone:352-615-4478
Mailing Address - Fax:
Practice Address - Street 1:5105 SE 39TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-0636
Practice Address - Country:US
Practice Address - Phone:352-615-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician