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General NPI Number Information
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NPI Number | 1679283352
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Entity Type | Individual
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Provider Name | GRETTY LEYVA ACOSTA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 2629 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-5769
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Country | US
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Telephone | 239-574-4434
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Fax | 239-574-6968
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Provider Business Mailing Address
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Address Line | 2629 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-5769
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Country | US
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Telephone | 239-574-4434
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Fax | 239-574-6968
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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 | OTA19214
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License Number State | FL
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