Provider Demographics
NPI:1477859494
Name:KOSTER, JAY A (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JAY
Middle Name:A
Last Name:KOSTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JAY
Other - Middle Name:D
Other - Last Name:ATENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2129 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3875
Mailing Address - Country:US
Mailing Address - Phone:321-259-6599
Mailing Address - Fax:717-412-5829
Practice Address - Street 1:2129 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3875
Practice Address - Country:US
Practice Address - Phone:321-259-6599
Practice Address - Fax:717-412-5829
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist