Healthcare Provider Details

I. General information

NPI: 1386894376
Provider Name (Legal Business Name): YVONNE ANITA GOTH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WESTSHORE BLVD STE 601
TAMPA FL
33609-1140
US

IV. Provider business mailing address

1655 S HIGHLAND AVE APT B215
CLEARWATER FL
33756-6384
US

V. Phone/Fax

Practice location:
  • Phone: 813-371-3416
  • Fax: 800-543-0372
Mailing address:
  • Phone: 727-204-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT5880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: