Provider Demographics
NPI:1871368894
Name:ERNST, KATLYN RYLEE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:RYLEE
Last Name:ERNST
Suffix:
Gender:F
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 1:12909 PARKINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3915
Mailing Address - Country:US
Mailing Address - Phone:727-735-7248
Mailing Address - Fax:
Practice Address - Street 1:1311 ASTON GARDENS CT
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-3824
Practice Address - Country:US
Practice Address - Phone:813-642-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist