Provider Demographics
NPI:1710667324
Name:DAMOSH, KERSTEN ANNA
Entity Type:Individual
Prefix:MS
First Name:KERSTEN
Middle Name:ANNA
Last Name:DAMOSH
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 1:6641 LAKESHORE LN APT 1134
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7100
Mailing Address - Country:US
Mailing Address - Phone:941-586-5206
Mailing Address - Fax:
Practice Address - Street 1:14410 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4341
Practice Address - Country:US
Practice Address - Phone:239-561-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT24427225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics