Provider Demographics
NPI:1215419452
Name:BAUTISTA, GABRIELLA MARIA (COTA)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARIA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13134 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3837
Mailing Address - Country:US
Mailing Address - Phone:954-249-7472
Mailing Address - Fax:
Practice Address - Street 1:13134 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3837
Practice Address - Country:US
Practice Address - Phone:954-249-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16755224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA16755OtherAMERICAN OCCUPATIONAL THERAPY ASSOCIATION