Provider Demographics
NPI:1215250618
Name:VIGELAND, KATHLEEN M (MS, TVI, IT DS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:VIGELAND
Suffix:
Gender:F
Credentials:MS, TVI, IT DS
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:GOLZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, TVI, ITDS
Mailing Address - Street 1:P.O. BOX 136
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-0136
Mailing Address - Country:US
Mailing Address - Phone:941-545-2323
Mailing Address - Fax:
Practice Address - Street 1:3637 FOURTH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1337
Practice Address - Country:US
Practice Address - Phone:941-545-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X, 2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind