Provider Demographics
NPI:1629431580
Name:GUTIERREZ, CINDY ADRIANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:ADRIANA
Last Name:GUTIERREZ
Suffix:
Gender:F
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 1:12185 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3120
Mailing Address - Country:US
Mailing Address - Phone:813-787-0086
Mailing Address - Fax:
Practice Address - Street 1:12185 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-3120
Practice Address - Country:US
Practice Address - Phone:813-787-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 15006224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant