Healthcare Provider Details

I. General information

NPI: 1396030169
Provider Name (Legal Business Name): MARIBEL GOTAY O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD. #3 KM 27.0
RIO GRANDE PR
00745
US

IV. Provider business mailing address

PO BOX 1978
CEIBA PR
00735-1978
US

V. Phone/Fax

Practice location:
  • Phone: 787-513-2828
  • Fax:
Mailing address:
  • Phone: 787-556-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1081
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: