Healthcare Provider Details

I. General information

NPI: 1437435740
Provider Name (Legal Business Name): JENNIFER ZABEL GONZALES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 S ALAFAYA TRL SUITE 200
ORLANDO FL
32828-8956
US

IV. Provider business mailing address

1561 S ALAFAYA TRL SUITE 200
ORLANDO FL
32828-8956
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-5551
  • Fax: 407-382-5637
Mailing address:
  • Phone: 407-382-5551
  • Fax: 407-382-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: