Provider Demographics
NPI:1689212367
Name:DRISKELL, KAYLA JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEAN
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16785 162ND ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-0403
Mailing Address - Country:US
Mailing Address - Phone:386-266-8579
Mailing Address - Fax:
Practice Address - Street 1:16785 162ND ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-0403
Practice Address - Country:US
Practice Address - Phone:386-266-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20368OtherFLORIDA LICENSE