MEDICARE: GABRIELL HERRERA OTR/L

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	OT22008	FL

General Provider Information

NPI Number	:	1891365409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELL HERRERA OTR/L

Provider Business Mailing Address
First Line	:	4423 W EL PRADO BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8301
Country	:	US
Telephone Number	:	813-629-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 N HABANA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7211
Country	:	US
Telephone Number	:	813-872-2771
Fax Number	:

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

Provider Enumeration Date	:	06/26/2021
Last Update Date	:	06/26/2021

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