Provider Demographics
NPI:1720569585
Name:PARKER, KAILIN CARROLL
Entity Type:Individual
Prefix:
First Name:KAILIN
Middle Name:CARROLL
Last Name:PARKER
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 1:15420 LIVINGSTON AVE APT 2715
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3414
Mailing Address - Country:US
Mailing Address - Phone:706-302-0948
Mailing Address - Fax:
Practice Address - Street 1:15420 LIVINGSTON AVE APT 2715
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-3414
Practice Address - Country:US
Practice Address - Phone:706-302-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer