Provider Demographics
NPI:1619176948
Name:BOBOS, KEVIN R (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:BOBOS
Suffix:
Gender:M
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 1:11708 PURE PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-9008
Mailing Address - Country:US
Mailing Address - Phone:813-741-1332
Mailing Address - Fax:
Practice Address - Street 1:11708 PURE PEBBLE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-9008
Practice Address - Country:US
Practice Address - Phone:813-741-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12771225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics