Provider Demographics
NPI:1023479169
Name:ODICE, KAITLIN (BS)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ODICE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 VERMONT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-7242
Mailing Address - Country:US
Mailing Address - Phone:941-400-9182
Mailing Address - Fax:
Practice Address - Street 1:4054 VERMONT LN
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7242
Practice Address - Country:US
Practice Address - Phone:941-400-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker