Healthcare Provider Details

I. General information

NPI: 1790258309
Provider Name (Legal Business Name): GYSELLE KRISTINE LLANA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13397 SW 131ST ST
MIAMI FL
33186-5816
US

IV. Provider business mailing address

13397 SW 131ST ST
MIAMI FL
33186-5816
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-0227
  • Fax:
Mailing address:
  • Phone: 305-232-0227
  • Fax: 786-219-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA16914
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT26094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: