Provider Demographics
NPI:1154666477
Name:TABUENA, MARYLOU TOBIAS (OTR)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:TOBIAS
Last Name:TABUENA
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 1:2600 HIGHLANDS BLVD N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2114
Mailing Address - Country:US
Mailing Address - Phone:727-785-5671
Mailing Address - Fax:727-786-2418
Practice Address - Street 1:2600 HIGHLANDS BLVD N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2114
Practice Address - Country:US
Practice Address - Phone:727-785-5671
Practice Address - Fax:727-786-2418
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist