Provider Demographics
NPI:1407239692
Name:HUTH, KYLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HUTH
Suffix:
Gender:M
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 1:360 DUNCAN LOOP E
Mailing Address - Street 2:APT 105
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-1334
Mailing Address - Country:US
Mailing Address - Phone:740-704-9546
Mailing Address - Fax:
Practice Address - Street 1:1980 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1132
Practice Address - Country:US
Practice Address - Phone:727-443-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant