Healthcare Provider Details

I. General information

NPI: 1104045236
Provider Name (Legal Business Name): PATRICIA KOBATA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E ORANGETHORPE AVE
PLACENTIA CA
92870-6723
US

IV. Provider business mailing address

3460 FAUST AVE
LONG BEACH CA
90808-2838
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-4800
  • Fax:
Mailing address:
  • Phone: 714-279-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: