Provider Demographics
NPI:1528275765
Name:KORNBLAU, BARBARA L (JD, OTR, CCM, CDMS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:KORNBLAU
Suffix:
Gender:F
Credentials:JD, OTR, CCM, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 SW 64TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1825
Mailing Address - Country:US
Mailing Address - Phone:305-666-4714
Mailing Address - Fax:305-667-6211
Practice Address - Street 1:3200 S UNIVERISTY DRIVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY OCCUPATIONAL THERAPY DEPT.
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-262-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0000783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist