Provider Demographics
NPI:1427562800
Name:KECKLER, JOY CARISSA (COTA)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:CARISSA
Last Name:KECKLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CROTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1479
Mailing Address - Country:US
Mailing Address - Phone:386-848-5875
Mailing Address - Fax:
Practice Address - Street 1:3301 CROTON AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-1479
Practice Address - Country:US
Practice Address - Phone:386-848-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16114224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant