Healthcare Provider Details

I. General information

NPI: 1417141714
Provider Name (Legal Business Name): GILDA TRAVIESO HARDEN OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 101
NORTH MIAMI BEACH FL
33169-5510
US

IV. Provider business mailing address

100 NW 170TH ST STE 101
NORTH MIAMI BEACH FL
33169-5510
US

V. Phone/Fax

Practice location:
  • Phone: 786-261-0222
  • Fax:
Mailing address:
  • Phone: 786-261-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: