Provider Demographics
NPI:1346566106
Name:GURDIAN, JACKELINE OLIVEIRA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACKELINE
Middle Name:OLIVEIRA
Last Name:GURDIAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JACKELINE
Other - Middle Name:
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:10175 SW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2617
Mailing Address - Country:US
Mailing Address - Phone:786-547-3738
Mailing Address - Fax:
Practice Address - Street 1:10175 SW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2617
Practice Address - Country:US
Practice Address - Phone:786-547-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist