Provider Demographics
NPI:1770683344
Name:GOTREAUX, TINA LEAH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LEAH
Last Name:GOTREAUX
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 1:8698 ALEXANDRITE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-7691
Mailing Address - Country:US
Mailing Address - Phone:850-933-7447
Mailing Address - Fax:850-877-9607
Practice Address - Street 1:1425 VILLAGE SQUARE BLVD
Practice Address - Street 2:STE. 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1271
Practice Address - Country:US
Practice Address - Phone:850-431-7110
Practice Address - Fax:850-431-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist