Provider Demographics
NPI:1497400980
Name:SANTICERMA, KELLIE NICOLE
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:NICOLE
Last Name:SANTICERMA
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 1:117 ISLAND SHORES DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2102
Mailing Address - Country:US
Mailing Address - Phone:561-628-4265
Mailing Address - Fax:
Practice Address - Street 1:117 ISLAND SHORES DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-2102
Practice Address - Country:US
Practice Address - Phone:561-628-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant