MEDICARE: RUTH GARDNER

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1962073460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GARDNER

Provider Business Mailing Address
First Line	:	5546 CINDERLANE PKWY APT C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4724
Country	:	US
Telephone Number	:	918-781-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 CINDERLANE PKWY APT C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4724
Country	:	US
Telephone Number	:	918-781-9630
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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Directions to “ RUTH GARDNER ” Practice Location

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