Provider Demographics
NPI:1699420620
Name:HUBBARD, KEITH JR (COTA/L)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HUBBARD
Suffix:JR
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 ALAFAYA PALMS DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7852
Mailing Address - Country:US
Mailing Address - Phone:904-707-2444
Mailing Address - Fax:
Practice Address - Street 1:3549 ALAFAYA PALMS DR UNIT 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7852
Practice Address - Country:US
Practice Address - Phone:904-707-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA-18260224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant