MEDICARE: MARGARITA LUCIA GOMEZ MS, OTR/L, RPF-I

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	225XP0200X	Pediatric Occupational Therapist	OT 806	CA

General Provider Information

NPI Number	:	1538549688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARITA LUCIA GOMEZ MS, OTR/L, RPF-I

Provider Business Mailing Address
First Line	:	2271 SHIBLEY AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4066
Country	:	US
Telephone Number	:	408-472-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	2271 SHIBLEY AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4066
Country	:	US
Telephone Number	:	408-472-0993
Fax Number	:

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

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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