Provider Demographics
NPI:1306171442
Name:SOULE, GLORIANGELES (OT)
Entity type:Individual
Prefix:
First Name:GLORIANGELES
Middle Name:
Last Name:SOULE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:JUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:442 WEKIVA COVE RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5600
Mailing Address - Country:US
Mailing Address - Phone:352-317-0206
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5061
Practice Address - Country:US
Practice Address - Phone:407-732-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist