Provider Demographics
NPI:1316133366
Name:WOULAS, KIM WINTERS (COTA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:WINTERS
Last Name:WOULAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ANNE
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:8435 ANTELOPE AVE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-1107
Mailing Address - Country:US
Mailing Address - Phone:321-727-9887
Mailing Address - Fax:321-727-9887
Practice Address - Street 1:8435 ANTELOPE AVE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-1107
Practice Address - Country:US
Practice Address - Phone:321-727-9887
Practice Address - Fax:321-727-9887
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9725224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant