Healthcare Provider Details

I. General information

NPI: 1336377373
Provider Name (Legal Business Name): MARLA HINKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLA DAVITT

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2698 LONGWOOD BLVD
MELBOURNE FL
32934-8235
US

IV. Provider business mailing address

2698 LONGWOOD BLVD
MELBOURNE FL
32934-8235
US

V. Phone/Fax

Practice location:
  • Phone: 321-254-3419
  • Fax:
Mailing address:
  • Phone: 321-254-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT2590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: