Healthcare Provider Details

I. General information

NPI: 1326953779
Provider Name (Legal Business Name): CARLY COBURN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 SW 54TH TER
PLANTATION FL
33317-6025
US

IV. Provider business mailing address

1761 SW 54TH TER
PLANTATION FL
33317-6025
US

V. Phone/Fax

Practice location:
  • Phone: 954-829-9013
  • Fax:
Mailing address:
  • Phone: 954-829-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: