Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT60669325 | WA |
NPI | 1003823360 |
---|---|
Provider Name | Mr. Florie Gonzales JR. |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 27/02/2017 |