Healthcare Provider Details

I. General information

NPI: 1811383201
Provider Name (Legal Business Name): PATRICIA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 09/18/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SW 43RD ST APT T4
GAINESVILLE FL
32607-3827
US

IV. Provider business mailing address

2300 SW 43RD ST APT T4
GAINESVILLE FL
32607-3827
US

V. Phone/Fax

Practice location:
  • Phone: 239-810-0525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15529
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number26918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: