Provider Demographics
NPI:1376713032
Name:KWAN, FLORENCE GOTICO (OTR)
Entity type:Individual
Prefix:MISS
First Name:FLORENCE
Middle Name:GOTICO
Last Name:KWAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 LIAM CT APT B
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4566
Mailing Address - Country:US
Mailing Address - Phone:417-629-2033
Mailing Address - Fax:
Practice Address - Street 1:1880 LIAM CT APT B
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4566
Practice Address - Country:US
Practice Address - Phone:417-629-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist