Provider Demographics
NPI:1447652854
Name:REVERS, COLBY (MS OTR/L)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:REVERS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3964 DEQUATTRO DR UNIT 7110
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-7521
Mailing Address - Country:US
Mailing Address - Phone:321-480-3011
Mailing Address - Fax:
Practice Address - Street 1:3964 DEQUATTRO DR UNIT 7110
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-7521
Practice Address - Country:US
Practice Address - Phone:321-480-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLY552110897190225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist