Provider Demographics
NPI:1134927502
Name:GATES, CAROLINE GRACE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:GRACE
Last Name:GATES
Suffix:
Gender:
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BAYSHORE BLVD APT 1906
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2387
Mailing Address - Country:US
Mailing Address - Phone:214-674-3148
Mailing Address - Fax:
Practice Address - Street 1:1320 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4860
Practice Address - Country:US
Practice Address - Phone:813-607-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist