Provider Demographics
NPI:1356746747
Name:UANINO, KELLY LOU (OTRL)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LOU
Last Name:UANINO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PIEDMONT DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7967
Mailing Address - Country:US
Mailing Address - Phone:850-270-7374
Mailing Address - Fax:850-270-5629
Practice Address - Street 1:1414 PIEDMONT DR E STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7967
Practice Address - Country:US
Practice Address - Phone:850-270-7374
Practice Address - Fax:850-270-5629
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15109225X00000X
FL15109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010113300Medicaid