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General NPI Number Information
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NPI Number | 1053055509
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Entity Type | Individual
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Provider Name | JAILINE GONZALEZ OTD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 5001 N NEBRASKA AVE SUITE A
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City | TAMPA
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State | FL
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Zip | 33603-2304
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Country | US
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Telephone | 813-879-6770
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Fax | 813-436-5637
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Provider Business Mailing Address
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Address Line | 3339 HANDY RD
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City | TAMPA
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State | FL
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Zip | 33618-4617
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Country | US
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Telephone | 863-234-9627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 26727
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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