Healthcare Provider Details

I. General information

NPI: 1144332263
Provider Name (Legal Business Name): JOHANNA ABADIAS GONZALEZ OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/28/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

IV. Provider business mailing address

1507 CENTER ST
GREEN COVE SPRINGS FL
32043-2113
US

V. Phone/Fax

Practice location:
  • Phone: 904-945-7556
  • Fax: 904-379-0113
Mailing address:
  • Phone: 904-837-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3264
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT13260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: