Individual
THARA GAUTHIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BHSC , COTA/L
Contact information
Practice address
900 S BABCOCK ST, MELBOURNE, FL 32901-1853
(321) 409-4800
Mailing address
385 SAN MARINO RD SW, PALM BAY, FL 32908-3334
(321) 987-7989
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18829
FL
Other
Enumeration date
04/07/2022
Last updated
04/07/2022
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