Individual
KIMBERLY LESCALETT HAZELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
15613 BEREA DR, ODESSA, FL 33556-3006
(813) 920-7304
Mailing address
15613 BEREA DR, ODESSA, FL 33556-3006
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT12651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002544100
—
FL
Enumeration date
07/15/2010
Last updated
02/17/2011
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