Healthcare Provider Details

I. General information

NPI: 1598988800
Provider Name (Legal Business Name): CYNTHIA MILOS KIRCHBERG OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

IV. Provider business mailing address

11311 3RD AVE E
BRADENTON FL
34212-1656
US

V. Phone/Fax

Practice location:
  • Phone: 941-355-7637
  • Fax: 941-358-3069
Mailing address:
  • Phone: 941-400-8650
  • Fax: 941-358-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 11085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: