Provider Demographics
NPI:1275766198
Name:MCCUBBIN, PATRICIA GONZALEZ (OT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GONZALEZ
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SW 131ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1135
Mailing Address - Country:US
Mailing Address - Phone:305-588-0812
Mailing Address - Fax:305-559-8182
Practice Address - Street 1:2250 SW 131ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1135
Practice Address - Country:US
Practice Address - Phone:305-588-0812
Practice Address - Fax:305-559-8182
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist