Provider Demographics
NPI:1558824235
Name:DAUBAR, KEVIN E
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:DAUBAR
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 1:815 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2018
Mailing Address - Country:US
Mailing Address - Phone:786-534-7172
Mailing Address - Fax:305-441-9069
Practice Address - Street 1:815 NW 57TH AVE STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2041
Practice Address - Country:US
Practice Address - Phone:786-534-7172
Practice Address - Fax:305-441-9069
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty