MEDICARE: JOHANNA ABADIAS GONZALEZ OTRL

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	3264	SC
2	225XP0200X	Pediatric Occupational Therapist	OT13260	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144332263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA ABADIAS GONZALEZ OTRL

Provider Business Mailing Address
First Line	:	1507 CENTER ST
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-2113
Country	:	US
Telephone Number	:	904-837-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1602
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6298
Country	:	US
Telephone Number	:	904-945-7556
Fax Number	:	904-379-0113

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/28/2022

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Directions to “ JOHANNA ABADIAS GONZALEZ OTRL” Practice Location

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