Individual provider Active NPI

Yaismelys Gonzalez Romero

  • Occupational Therapy Assistant
  • Lehigh Acres, FL
National Provider Identifier
1205329778
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA16243 Issued in FL
Practice address
5598 8TH St W Unit 3
Lehigh Acres, FL 33971-6341
Phone
(239) 491-3057
Fax
(239) 491-3057
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 224Z00000X OTA16243 FL Primary

Addresses

Primary practice location

5598 8TH St W Unit 3
Lehigh Acres, FL 33971-6341

Mailing address

5598 8TH St W Unit 3
Lehigh Acres, FL 33971-6341
Phone (239) 491-3057

Other identifiers 1

IdentifierTypeStateIssuer
006236000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA16243FLMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1205329778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5598 8TH ST W UNIT 3",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339716341",
            "telephone_number": "239-491-3057",
            "fax_number": "239-491-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5598 8TH ST W UNIT 3",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339716341",
            "telephone_number": "239-491-3057",
            "fax_number": "239-491-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ ROMERO",
        "first_name": "YAISMELYS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA16243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006236000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.