Provider Demographics
NPI:1538918966
Name:GORIS, TEANNIE (OTR/L)
Entity type:Individual
Prefix:
First Name:TEANNIE
Middle Name:
Last Name:GORIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 MERIDIAN AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6264
Mailing Address - Country:US
Mailing Address - Phone:914-329-9862
Mailing Address - Fax:
Practice Address - Street 1:729 MERIDIAN AVE APT 10
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6264
Practice Address - Country:US
Practice Address - Phone:914-329-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist