Caylee Jacquelyn Banta, OTD, OTR/L
Individual provider Active NPI Occupational Therapist · Rockledge, FL
NPI 1225430903 · NPPES record last updated May 31, 2018
Key facts
- NPI
- 1225430903
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT15225 (FL)
- Practice address
- 2260 Bridgeport Cir
Rockledge, FL 32955 - Phone
- (321) 446-2742
- NPI assigned
- Sep 24, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT15225 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banta Therapy Incorporated | Occupational Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT15225 | FL | Yes |
Addresses
Primary practice location
2260 Bridgeport Cir
Rockledge, FL 32955
Mailing address
2260 Bridgeport Cir
Rockledge, FL 32955-4344
Phone (321) 446-2742
Other practice location 1
1555 DAlbora Rd
Merritt Island, FL 32953-7132
Phone (321) 446-2742
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225430903 | Medicaid | FL |
Other providers in Rockledge, FL
- Jessica Baez
- Cheryl Bailey
- Michael Peter Bailey
- Nicole Bairossi
- Amy L Balog
- David Joseph Banta
- Derrick Banyard Jr.
- Theresa Barcus
- Robert E Barden
- Nikki Barnett
All providers in Rockledge, FL · Occupational Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.