Provider Demographics
NPI:1700409786
Name:CABAN, GERYMARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:GERYMARIE
Middle Name:
Last Name:CABAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 GERBER DAISY LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-6688
Mailing Address - Country:US
Mailing Address - Phone:407-666-9516
Mailing Address - Fax:
Practice Address - Street 1:3488 GERBER DAISY LN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32766-6688
Practice Address - Country:US
Practice Address - Phone:407-666-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist