Provider Demographics
NPI:1487181954
Name:GOMEZ-HERRERA, ANDERSON (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:GOMEZ-HERRERA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FIR TRAIL TRCE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-4296
Mailing Address - Country:US
Mailing Address - Phone:352-216-9163
Mailing Address - Fax:
Practice Address - Street 1:4100 SW 33RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4466
Practice Address - Country:US
Practice Address - Phone:352-854-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12049224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant