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General NPI Number Information
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NPI Number | 1730374026
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Entity Type | Individual
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Provider Name | DONNA MARIE GONZALEZ OTR
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 2636 S MILFORD RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4938
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Country | US
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Telephone | 248-684-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 13450 LAKEBROOK DR
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City | FENTON
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State | MI
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Zip | 48430-8420
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Country | US
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Telephone | 810-629-1245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 5201000264
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License Number State | MI
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