MEDICARE: MAURICIO OSCAR GONZALEZ REYNALDO SR. 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	OT20252	FL

General Provider Information

NPI Number	:	1962931717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO OSCAR GONZALEZ REYNALDO SR. OTR/L

Provider Business Mailing Address
First Line	:	6165 SW 130TH AVE APT 1310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5234
Country	:	US
Telephone Number	:	786-370-8729
Fax Number	:	305-830-9043

Provider Business Practice Location Address
First Line	:	6165 SW 130TH AVE APT 1310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5234
Country	:	US
Telephone Number	:	786-370-8729
Fax Number	:	305-830-9043

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	01/30/2025

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Directions to “ MAURICIO OSCAR GONZALEZ REYNALDO SR. OTR/L” Practice Location

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