MEDICARE: MS. TERESA M GUTIERREZ OT CHT

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	OT364	FL
2	225X00000X	Occupational Therapist	OT002560	GA
3	225X00000X	Occupational Therapist	CHT9105000452	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	:	1831152131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA M GUTIERREZ OT CHT

Provider Business Mailing Address
First Line	:	405 RACETRACK RD NE
Second Line	:	SUITE 101
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2561
Country	:	US
Telephone Number	:	850-863-4747
Fax Number	:	850-863-4658

Provider Business Practice Location Address
First Line	:	405 RACETRACK RD NE
Second Line	:	SUITE 101
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2561
Country	:	US
Telephone Number	:	850-863-4747
Fax Number	:	850-863-4658

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	04/01/2016

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