Healthcare Provider Details

I. General information

NPI: 1952536112
Provider Name (Legal Business Name): LARRY DAVID KUWIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S RIVER RD
ENGLEWOOD FL
34223-3909
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 941-475-3516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA7663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: