Provider Demographics
NPI:1568968337
Name:PONCE, GABRIELA (OT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W SHANNON LAKES DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2240
Mailing Address - Country:US
Mailing Address - Phone:850-942-2000
Mailing Address - Fax:850-942-2003
Practice Address - Street 1:4500 W SHANNON LAKES DR STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2240
Practice Address - Country:US
Practice Address - Phone:850-942-2000
Practice Address - Fax:850-942-2003
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist