Provider Demographics
NPI:1679192892
Name:BERNER, KAYLIN ASHLEY (MT-BC)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:ASHLEY
Last Name:BERNER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 BRIGHTON BAY BLVD NE BLDG NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3478
Mailing Address - Country:US
Mailing Address - Phone:321-213-7390
Mailing Address - Fax:
Practice Address - Street 1:7333 INTERNATIONAL PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8418
Practice Address - Country:US
Practice Address - Phone:941-527-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15719225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist