Provider Demographics
NPI:1053613604
Name:KASPUTIS, BREANN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:
Last Name:KASPUTIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 US HIGHWAY 98 S
Mailing Address - Street 2:STE. 6
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-8365
Mailing Address - Country:US
Mailing Address - Phone:863-667-3092
Mailing Address - Fax:863-667-3142
Practice Address - Street 1:3317 US HIGHWAY 98 S
Practice Address - Street 2:STE. 6
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-8365
Practice Address - Country:US
Practice Address - Phone:863-667-3092
Practice Address - Fax:863-667-3142
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist