Provider Demographics
NPI:1356616304
Name:AMMONS, GLORIA YOLANDA (OTA 7839)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:YOLANDA
Last Name:AMMONS
Suffix:
Gender:F
Credentials:OTA 7839
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PRESTIGE DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1240
Mailing Address - Country:US
Mailing Address - Phone:651-628-1812
Mailing Address - Fax:
Practice Address - Street 1:131 PRESTIGE DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1240
Practice Address - Country:US
Practice Address - Phone:651-628-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 7839224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant