Provider Demographics
NPI:1962174243
Name:CANTERBERRY, CAYSI
Entity type:Individual
Prefix:
First Name:CAYSI
Middle Name:
Last Name:CANTERBERRY
Suffix:
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 1:11990 SW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4498
Mailing Address - Country:US
Mailing Address - Phone:954-305-8133
Mailing Address - Fax:
Practice Address - Street 1:11990 SW 49TH CT
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-4498
Practice Address - Country:US
Practice Address - Phone:954-305-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18599224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA18599OtherFLORIDA DEPARTMENT OF HEALTH