Provider Demographics
NPI:1326431065
Name:GREBOSZ, KASEY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:GREBOSZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 HEATH DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3097
Mailing Address - Country:US
Mailing Address - Phone:386-848-2749
Mailing Address - Fax:
Practice Address - Street 1:3434 HEATH DRIVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3097
Practice Address - Country:US
Practice Address - Phone:386-848-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11891224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant