MEDICARE: MS. JAILINE GONZALEZ OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	26727	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053055509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAILINE GONZALEZ OTD

Provider Business Mailing Address
First Line	:	3339 HANDY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4617
Country	:	US
Telephone Number	:	863-234-9627
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 N NEBRASKA AVE
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33603-2304
Country	:	US
Telephone Number	:	813-879-6770
Fax Number	:	813-436-5637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	01/02/2026

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