Provider Demographics
NPI:1336377373
Name:HINKLE, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:HINKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:DAVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2698 LONGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8235
Mailing Address - Country:US
Mailing Address - Phone:321-254-3419
Mailing Address - Fax:
Practice Address - Street 1:2698 LONGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8235
Practice Address - Country:US
Practice Address - Phone:321-254-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2590225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology