Individual
EVITA GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
587 SE ERMINE AVE, LAKE CITY, FL 32025-6126
(386) 752-7800
Mailing address
2531 BELMONT AVE, NEW SMYRNA, FL 32168-5806
(386) 631-4192
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
15960
FL
Other
Enumeration date
09/27/2017
Last updated
09/27/2017
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