Provider Demographics
NPI:1841330461
Name:EICENS, KARI DEMARIS (COTA)
Entity type:Individual
Prefix:MS
First Name:KARI
Middle Name:DEMARIS
Last Name:EICENS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 EULACE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8026
Mailing Address - Country:US
Mailing Address - Phone:904-535-3943
Mailing Address - Fax:904-541-0616
Practice Address - Street 1:524 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4830
Practice Address - Country:US
Practice Address - Phone:904-215-7200
Practice Address - Fax:904-541-0616
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA6788224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant