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General NPI Number Information
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NPI Number | 1083846364
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Entity Type | Individual
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Provider Name | PATRICIA KOWALCHUK OTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 6050 ST.JOHNS AVE., SUITE A
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City | PALATKA
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State | FL
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Zip | 32177
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Country | US
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Telephone | 386-312-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 6841 BIG SKY LN
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City | MELROSE
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State | FL
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Zip | 32666-8932
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Country | US
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Telephone | 352-494-9434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA8018
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License Number State | FL
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