Healthcare Provider Details

I. General information

NPI: 1508445958
Provider Name (Legal Business Name): SANTOS GABRIELA AGUILAR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N CENTRAL AVE
KISSIMMEE FL
34741-4450
US

IV. Provider business mailing address

1200 N CENTRAL AVE
KISSIMMEE FL
34741-4450
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-7429
  • Fax: 877-399-5578
Mailing address:
  • Phone: 407-201-7429
  • Fax: 877-399-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: