Provider Demographics
NPI:1326609785
Name:VILLEGAS, GISELLE (OTA RBT)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:OTA RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 NW 194TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2080
Mailing Address - Country:US
Mailing Address - Phone:786-541-4343
Mailing Address - Fax:
Practice Address - Street 1:5135 NW 194TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2080
Practice Address - Country:US
Practice Address - Phone:786-541-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15337224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty