Provider Demographics
NPI:1922327212
Name:GAVINO, JULIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GAVINO
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 1:3550 BISCAYNE BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3854
Mailing Address - Country:US
Mailing Address - Phone:305-572-0492
Mailing Address - Fax:
Practice Address - Street 1:3550 BISCAYNE BOULEVARD # 407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3854
Practice Address - Country:US
Practice Address - Phone:305-572-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10942224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant