Provider Demographics
NPI:1316506645
Name:MENESES, GABRIELA (OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:MENESES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:MENESES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:695 YOUNGSTOWN PKWY APT 292
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4531
Mailing Address - Country:US
Mailing Address - Phone:407-748-6392
Mailing Address - Fax:
Practice Address - Street 1:4680 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1182
Practice Address - Country:US
Practice Address - Phone:407-852-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist