Provider Demographics
NPI:1851029805
Name:GOMEZ MOGOLLON, ZAIREE (COTA)
Entity Type:Individual
Prefix:
First Name:ZAIREE
Middle Name:
Last Name:GOMEZ MOGOLLON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LIZETTE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3807
Mailing Address - Country:US
Mailing Address - Phone:201-757-9885
Mailing Address - Fax:
Practice Address - Street 1:49 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2580
Practice Address - Country:US
Practice Address - Phone:718-473-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant