Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 111745 | TX |
NPI | 1003935297 |
---|---|
Provider Name | Deanna Maria Gonzalez |
First Address | Killeen, TX 76542-7812 |
Second Address | Fort Hood, TX 76544-5063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |