Healthcare Provider Details

I. General information

NPI: 1821022112
Provider Name (Legal Business Name): IVETTE MARIA DUBOY GONZALEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17786 SW 139TH CT
MIAMI FL
33177-7741
US

IV. Provider business mailing address

17786 SW 139 COURT
MIAMI FL
33177
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-6276
  • Fax:
Mailing address:
  • Phone: 786-316-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT7006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: