Individual
CAYLEE JACQUELYN BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
2260 BRIDGEPORT CIR, ROCKLEDGE, FL 32955
(321) 446-2742
Mailing address
2260 BRIDGEPORT CIR, ROCKLEDGE, FL 32955-4344
(321) 446-2742
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT15225
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225430903
—
FL
Enumeration date
09/24/2014
Last updated
05/31/2018
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