Provider Demographics
NPI:1760508600
Name:GARCIA, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16519 ENCLAVE VILLAGE DRIVE
Mailing Address - Street 2:APT # 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16519 ENCLAVE VILLAGE DR
Practice Address - Street 2:APT # 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-5109
Practice Address - Country:US
Practice Address - Phone:813-345-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA10311OtherPROFESSIONAL LICENCE