Provider Demographics
NPI:1043632748
Name:GAUTIER, GLORIA ENID (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ENID
Last Name:GAUTIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:ENID
Other - Last Name:NIEVES MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13126 PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8722
Mailing Address - Country:US
Mailing Address - Phone:407-201-7749
Mailing Address - Fax:407-201-8291
Practice Address - Street 1:13126 PALOMA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8722
Practice Address - Country:US
Practice Address - Phone:407-201-7749
Practice Address - Fax:407-201-8291
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 6470314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility