Healthcare Provider Details

I. General information

NPI: 1518406594
Provider Name (Legal Business Name): GABRIELA ITTAH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N UNIVERSITY DR SUITE 5
HOLLYWOOD FL
33024-2200
US

IV. Provider business mailing address

3335 N UNIVERSITY DR SUITE 5
HOLLYWOOD FL
33024-2200
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax: 954-442-9150
Mailing address:
  • Phone: 954-442-9422
  • Fax: 954-442-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: