Healthcare Provider Details

I. General information

NPI: 1366543076
Provider Name (Legal Business Name): JEAN KOSNIK COLYER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RIDGEWOOD AVE
BRANDON LA
33510
US

IV. Provider business mailing address

1352 CORNER OAKS DRIVE
BRANDON FL
33510
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-1060
  • Fax:
Mailing address:
  • Phone: 813-681-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 1478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: