Provider Demographics
NPI:1407195886
Name:GOMEZ-PENA, NAYRA LISETH (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MS
First Name:NAYRA
Middle Name:LISETH
Last Name:GOMEZ-PENA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MEEHAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2970
Mailing Address - Country:US
Mailing Address - Phone:321-507-8267
Mailing Address - Fax:
Practice Address - Street 1:287 MEEHAN AVE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2970
Practice Address - Country:US
Practice Address - Phone:321-507-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0T19153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist