Healthcare Provider Details

I. General information

NPI: 1720291750
Provider Name (Legal Business Name): JANETH GONZALEZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

15125 WOODLORE DRIVE
BATON ROUGE LA
70816
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11475
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: