Healthcare Provider Details

I. General information

NPI: 1326448994
Provider Name (Legal Business Name): MARISSA ROSE KOBYLSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 SE EAST SNOW RD
PORT SAINT LUCIE FL
34984-6412
US

IV. Provider business mailing address

3314 SE EAST SNOW RD
PORT SAINT LUCIE FL
34984-6412
US

V. Phone/Fax

Practice location:
  • Phone: 772-418-1640
  • Fax:
Mailing address:
  • Phone: 772-418-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: