Provider Demographics
NPI:1477825834
Name:DOBERSTEIN, IVONA BOQUMILA (OTR/L)
Entity Type:Individual
Prefix:
First Name:IVONA
Middle Name:BOQUMILA
Last Name:DOBERSTEIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3553
Mailing Address - Country:US
Mailing Address - Phone:828-393-5168
Mailing Address - Fax:865-951-7273
Practice Address - Street 1:68 BREEZY VALLEY CONNECTOR
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3054
Practice Address - Country:US
Practice Address - Phone:724-816-1800
Practice Address - Fax:865-951-7273
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist