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General NPI Number Information
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NPI Number | 1487181954
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Entity Type | Individual
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Provider Name | ANDERSON GOMEZ-HERRERA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 4100 SW 33RD AVE
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City | OCALA
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State | FL
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Zip | 34474-4466
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Country | US
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Telephone | 352-854-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FIR TRAIL TRCE
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City | OCALA
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State | FL
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Zip | 34472-4296
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Country | US
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Telephone | 352-216-9163
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA12049
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License Number State | FL
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