Provider Demographics
NPI:1457598435
Name:SMITH, GLORIA IVETT (COTA/L)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:IVETT
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:209 DANUBE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2186
Mailing Address - Country:US
Mailing Address - Phone:561-373-7062
Mailing Address - Fax:561-752-8528
Practice Address - Street 1:3301 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4642
Practice Address - Country:US
Practice Address - Phone:561-736-8380
Practice Address - Fax:561-752-8528
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 187224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant