MEDICARE: RUTH GARCIA

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	224Z00000X	Occupational Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTA10311	OTHER	FL	PROFESSIONAL LICENCE

General Provider Information

NPI Number	:	1760508600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GARCIA

Provider Business Mailing Address
First Line	:	16519 ENCLAVE VILLAGE DRIVE
Second Line	:	APT # 203
City	:	TAMPA
State	:	FL
Zip	:	33647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16519 ENCLAVE VILLAGE DR
Second Line	:	APT # 203
City	:	TAMPA
State	:	FL
Zip	:	33647-5109
Country	:	US
Telephone Number	:	813-345-5616
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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