Provider Demographics
NPI:1952686883
Name:ROBERTS, MIRIAM LOVESTRAND (COTA/L)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LOVESTRAND
Last Name:ROBERTS
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 1:2108 KILMER LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 TONINA CV
Practice Address - Street 2:STE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3442
Practice Address - Country:US
Practice Address - Phone:407-388-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
FL10632171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty