Provider Demographics
NPI:1699793554
Name:KERSEY, CARLA RENA (OTR/L)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RENA
Last Name:KERSEY
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 1:266 KIDD ST
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4478
Mailing Address - Country:US
Mailing Address - Phone:850-582-2689
Mailing Address - Fax:850-244-0971
Practice Address - Street 1:266 KIDD ST
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4478
Practice Address - Country:US
Practice Address - Phone:850-582-2689
Practice Address - Fax:850-244-0971
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1047225XP0200X
FLOT0001047225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88045088Medicaid
FL002115800Medicaid
FL880450800Medicaid
FL103169100Medicaid