Provider Demographics
NPI:1518544972
Name:LOUIS, ROBERT MARKUS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARKUS
Last Name:LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 JACKSON ST APT 22
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7623
Mailing Address - Country:US
Mailing Address - Phone:386-341-6759
Mailing Address - Fax:
Practice Address - Street 1:3656 JACKSON ST APT 22
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7623
Practice Address - Country:US
Practice Address - Phone:386-341-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13381224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant