MEDICARE: MS. YVONNE ANITA GOTH OTR

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	OT5880	FL

General Provider Information

NPI Number	:	1386894376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YVONNE ANITA GOTH OTR

Provider Business Mailing Address
First Line	:	1655 S HIGHLAND AVE APT B215
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-6384
Country	:	US
Telephone Number	:	727-204-1079
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N WESTSHORE BLVD STE 601
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1140
Country	:	US
Telephone Number	:	813-371-3416
Fax Number	:	800-543-0372

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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