Provider Demographics
NPI:1699275156
Name:GOGARTY, KATHRYN PAIGE (OTR)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PAIGE
Last Name:GOGARTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9373 FONTAINEBLEAU BLVD APT K208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5698
Mailing Address - Country:US
Mailing Address - Phone:786-290-6206
Mailing Address - Fax:
Practice Address - Street 1:5580 W 16TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2189
Practice Address - Country:US
Practice Address - Phone:305-456-2646
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG263515796040OtherDRIVER LICENSE