Individual
MRS. KATHLEEN ELLEN BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
2910 SE 7TH ST, OCALA, FL 34471-2768
(352) 620-2272
(352) 620-2272
Mailing address
2910 SE 7TH ST, OCALA, FL 34471-2768
(352) 620-2272
(352) 620-2272
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT354
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z1623
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/19/2007
Last updated
07/09/2007
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