Healthcare Provider Details

I. General information

NPI: 1295893535
Provider Name (Legal Business Name): YURIDIA GARZA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YURIDIA GARZA OT

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

IV. Provider business mailing address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax: 770-615-0177
Mailing address:
  • Phone: 770-615-7676
  • Fax: 770-615-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT003657
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: