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General NPI Number Information
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NPI Number | 1831152131
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Entity Type | Individual
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Provider Name | TERESA M GUTIERREZ OT CHT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 405 RACETRACK RD NE SUITE 101
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2561
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Country | US
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Telephone | 850-863-4747
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Fax | 850-863-4658
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Provider Business Mailing Address
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Address Line | 405 RACETRACK RD NE SUITE 101
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2561
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Country | US
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Telephone | 850-863-4747
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Fax | 850-863-4658
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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 | OT364
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT002560
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | CHT9105000452
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License Number State | FL
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