Provider Demographics
NPI:1437514221
Name:KUBLICK, ROBIN E (COTA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:KUBLICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 BRECKENRIDGE LN
Mailing Address - Street 2:APT 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3145
Mailing Address - Country:US
Mailing Address - Phone:502-345-1331
Mailing Address - Fax:
Practice Address - Street 1:3404 BRECKENRIDGE LN
Practice Address - Street 2:APT 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3145
Practice Address - Country:US
Practice Address - Phone:502-345-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOTA00222805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYBOTOTA00222805OtherKBLOT