Provider Demographics
NPI:1508093170
Name:GAMBA-RIVERA, MELY MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELY
Middle Name:MARIE
Last Name:GAMBA-RIVERA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 CYPRESS RD
Mailing Address - Street 2:UNIT 512
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3092
Mailing Address - Country:US
Mailing Address - Phone:954-655-1461
Mailing Address - Fax:305-512-5755
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-512-5757
Practice Address - Fax:305-512-5755
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOTA 10491224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant