Provider Demographics
NPI:1982028809
Name:ROSS, KATHRYN MARIE X
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:MARIE
Last Name:ROSS
Suffix:X
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 1:11751 COLLEGE PARK TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3976
Mailing Address - Country:US
Mailing Address - Phone:954-993-2802
Mailing Address - Fax:
Practice Address - Street 1:11751 COLLEGE PARK TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3976
Practice Address - Country:US
Practice Address - Phone:954-993-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR200513947460222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist