Provider Demographics
NPI:1104045236
Name:KOBATA, PATRICIA (OTR)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KOBATA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2838
Mailing Address - Country:US
Mailing Address - Phone:714-279-4800
Mailing Address - Fax:
Practice Address - Street 1:2031 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6723
Practice Address - Country:US
Practice Address - Phone:714-279-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist