Provider Demographics
NPI:1518223353
Name:MORALES, KENYETTA FRANCINE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KENYETTA
Middle Name:FRANCINE
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95139 JEANA LN
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-7498
Mailing Address - Country:US
Mailing Address - Phone:704-604-4699
Mailing Address - Fax:
Practice Address - Street 1:95139 JEANA LN
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-7498
Practice Address - Country:US
Practice Address - Phone:704-604-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106450100Medicaid