Provider Demographics
NPI:1518279991
Name:GOMEZ SOSA, MAYTE (OTR)
Entity type:Individual
Prefix:
First Name:MAYTE
Middle Name:
Last Name:GOMEZ SOSA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MAYTE
Other - Middle Name:
Other - Last Name:GOMEZ SOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:102 E NEW HAVEN AVE # 173
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4502
Mailing Address - Country:US
Mailing Address - Phone:321-604-9881
Mailing Address - Fax:
Practice Address - Street 1:102 E NEW HAVEN AVE # 173
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4502
Practice Address - Country:US
Practice Address - Phone:321-604-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist