Provider Demographics
NPI:1295893535
Name:GARZA, YURIDIA (OT)
Entity type:Individual
Prefix:MISS
First Name:YURIDIA
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:YURIDIA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:500 SPRING ST SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3773
Mailing Address - Country:US
Mailing Address - Phone:770-615-7676
Mailing Address - Fax:770-615-0177
Practice Address - Street 1:500 SPRING ST SE STE 101
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3773
Practice Address - Country:US
Practice Address - Phone:770-615-7676
Practice Address - Fax:770-615-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003657225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA141263118AMedicaid