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Individual

ALICIA KOPP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5103 17TH AVE S, GULFPORT, FL 33707-4377
(781) 974-2471
Mailing address
5103 17TH AVE S, GULFPORT, FL 33707-4377
(781) 974-2471

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
225X00000X
Occupational Therapist
Primary
225XP0200X
Pediatric Occupational Therapist
OT20568
FL

Other

Enumeration date
09/26/2016
Last updated
04/16/2024
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