Marie Olivas-Gomez, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT18827 Issued in FL

Practice address

427 Burns Ave
Lake Wales, FL 33853

Phone

(863) 679-3338

NPI assigned

Sep 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marie Olivas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Victory Ridge Academy, Inc.

  • Clinic/Center
  • Lake Wales, FL
  • NPI 1184044612

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1629404785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18539 SW 12TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330296017",
            "telephone_number": "954-696-8023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 BURNS AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33853",
            "telephone_number": "863-679-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVAS-GOMEZ",
        "first_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-20",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT18827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023097200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "OLIVAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anghitha Nimil, DDS
• Boris Dalton Nunez, M.D.
• Laporsha D Oguntola
• Olatunji Sarafadeen Olaoye, MD
• Ermante Olius
• Amanda Swick Olmert
• Arlese Charlette Olson, O.D
• On the Beat Cleaning LLC
• Oscar Amador Oropeza, M.D.
• Our Children's Academy

• Occupational Therapist in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; 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.