Healthcare Provider Details

I. General information

NPI: 1235385212
Provider Name (Legal Business Name): MERCEDES GAMEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE SUITE 113
HIALEAH FL
33015-3664
US

IV. Provider business mailing address

17920 NW 78TH CT
HIALEAH FL
33015-2811
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-5757
  • Fax: 305-512-5755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: