Individual
KHALLILAH GONSALVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6641 W WEDGEWOOD AVE, DAVIE, FL 33331-2915
(954) 618-7333
Mailing address
6641 W WEDGEWOOD AVE, DAVIE, FL 33331-2915
(954) 618-7333
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11778
FL
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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