Provider Demographics
NPI:1578607271
Name:KULESA, KATHLEEN A
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:KULESA
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 1:2850 COUNTRYBROOK DR APT F-23
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4847
Mailing Address - Country:US
Mailing Address - Phone:720-289-5864
Mailing Address - Fax:
Practice Address - Street 1:6474 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6748
Practice Address - Country:US
Practice Address - Phone:278-460-5477
Practice Address - Fax:727-847-0755
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21087225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
007340OtherKAISER-COMMERCIAL NUMBER