Provider Demographics
NPI:1588432553
Name:GAUZENS, CHANEL JANNIS (COTA)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:JANNIS
Last Name:GAUZENS
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 1:600 CURTISS PKWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5250
Mailing Address - Country:US
Mailing Address - Phone:786-616-5282
Mailing Address - Fax:
Practice Address - Street 1:5651 SW 82ND AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-1617
Practice Address - Country:US
Practice Address - Phone:305-275-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19724224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant