Healthcare Provider Details

I. General information

NPI: 1912373994
Provider Name (Legal Business Name): ROBERT C. O'QUINN JR. MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N SCENIC HWY
BABSON PARK FL
33827-9751
US

IV. Provider business mailing address

878 REFLECTIONS LOOP E
WINTER HAVEN FL
33884-3567
US

V. Phone/Fax

Practice location:
  • Phone: 863-638-1431
  • Fax:
Mailing address:
  • Phone: 316-655-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 4307
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00892
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: