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General NPI Number Information
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NPI Number | 1174683445
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Entity Type | Individual
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Provider Name | ROSA A GARDINER OTRL
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Gender | Female
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 3452 LAKE LYNDA DR STE 200
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City | ORLANDO
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State | FL
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Zip | 32817-1481
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Country | US
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Telephone | 407-308-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BRANNAN PL UNIT 103
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City | SAINT JOHNS
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State | FL
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Zip | 32259-6981
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Country | US
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Telephone | 334-400-4806
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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 | 20102
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2271
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License Number State | AL
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