Provider Demographics
NPI:1871864231
Name:KITTLE, VAJA MALIA
Entity Type:Individual
Prefix:MS
First Name:VAJA
Middle Name:MALIA
Last Name:KITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VAJA
Other - Middle Name:MALIA
Other - Last Name:KITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1019 HORNBEAM ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6030
Mailing Address - Country:US
Mailing Address - Phone:407-463-6488
Mailing Address - Fax:
Practice Address - Street 1:710 N SUN DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2507
Practice Address - Country:US
Practice Address - Phone:407-463-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist