Healthcare Provider Details

I. General information

NPI: 1790028272
Provider Name (Legal Business Name): ANNA LIVIA HURKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 S RENELLIE DR
TAMPA FL
33629-8350
US

IV. Provider business mailing address

3606 S RENELLIE DR
TAMPA FL
33629-8350
US

V. Phone/Fax

Practice location:
  • Phone: 856-889-5881
  • Fax:
Mailing address:
  • Phone: 856-889-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17122
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: