MEDICARE: MRS. AUDRA GOTT MA, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	2744	CA

General Provider Information

NPI Number	:	1194171017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDRA GOTT MA, OTR/L

Provider Business Mailing Address
First Line	:	27200 TOURNEY RD
Second Line	:	SUITE 255
City	:	VALENCIA
State	:	CA
Zip	:	91355-4990
Country	:	US
Telephone Number	:	661-222-9901
Fax Number	:	661-222-9326

Provider Business Practice Location Address
First Line	:	27200 TOURNEY RD
Second Line	:	SUITE 255
City	:	VALENCIA
State	:	CA
Zip	:	91355-4990
Country	:	US
Telephone Number	:	661-222-9901
Fax Number	:	661-222-9326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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