Healthcare Provider Details

I. General information

NPI: 1174347165
Provider Name (Legal Business Name): KHILIE OUBRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 SW 8TH ST
CORAL GABLES FL
33134-2476
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-1585
  • Fax:
Mailing address:
  • Phone: 603-893-4515
  • Fax: 866-420-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number324399
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: