Provider Demographics
NPI:1679369177
Name:LONGHOFER, KYLE EVAN (OTR/L)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:EVAN
Last Name:LONGHOFER
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 WOODLAND HILLS CT
Mailing Address - Street 2:
Mailing Address - City:HOWEY IN THE HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34737-4112
Mailing Address - Country:US
Mailing Address - Phone:321-514-3126
Mailing Address - Fax:
Practice Address - Street 1:7470 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6428
Practice Address - Country:US
Practice Address - Phone:352-873-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT26070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist