Provider Demographics
NPI:1659740579
Name:URDAZ, KATHLYN E (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:E
Last Name:URDAZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4439
Mailing Address - Country:US
Mailing Address - Phone:800-378-7597
Mailing Address - Fax:877-399-5578
Practice Address - Street 1:1200 N CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4439
Practice Address - Country:US
Practice Address - Phone:800-378-7597
Practice Address - Fax:877-399-5578
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14562224Z00000X
FLOT23852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant