Provider Demographics
NPI:1164056370
Name:MCLEOD, GAURA K (OTR/L,MOT)
Entity Type:Individual
Prefix:
First Name:GAURA
Middle Name:K
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:OTR/L,MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2851
Mailing Address - Country:US
Mailing Address - Phone:352-792-5035
Mailing Address - Fax:
Practice Address - Street 1:925 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2851
Practice Address - Country:US
Practice Address - Phone:352-792-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19440225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19440OtherSTATE OF FLORIDA OT LICENSE