Provider Demographics
NPI:1982088373
Name:REYES, KARLA (COTA)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:REYES
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 1:4803 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2818
Mailing Address - Country:US
Mailing Address - Phone:954-708-7821
Mailing Address - Fax:
Practice Address - Street 1:2685 EXECUTIVE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-515-0892
Practice Address - Fax:954-349-0896
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant