Provider Demographics
NPI:1225102072
Name:CUNNEEN, GLORIA ANNE (OTRL)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANNE
Last Name:CUNNEEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 TERRA MAR DR APT 208
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7103
Mailing Address - Country:US
Mailing Address - Phone:954-729-1241
Mailing Address - Fax:
Practice Address - Street 1:700 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7678
Practice Address - Country:US
Practice Address - Phone:954-247-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8843112 00Medicaid