Healthcare Provider Details

I. General information

NPI: 1285399022
Provider Name (Legal Business Name): ROSA KUCHLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N ASHLEY DRIVE STE 1900
TAMPA FL
33602-3360
US

IV. Provider business mailing address

108 S KANNER HWY
STUART FL
34994-2106
US

V. Phone/Fax

Practice location:
  • Phone: 813-573-5824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-191204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: