Provider Demographics
NPI:1518488030
Name:GRESENS, KAREN MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:GRESENS
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 1:2540 ANN ROU RD UNIT 1408
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5298
Mailing Address - Country:US
Mailing Address - Phone:407-401-2330
Mailing Address - Fax:
Practice Address - Street 1:609 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6319
Practice Address - Country:US
Practice Address - Phone:352-805-4404
Practice Address - Fax:877-399-5541
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15535252Y00000X, 224Z00000X
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No252Y00000XAgenciesEarly Intervention Provider Agency