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General NPI Number Information
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NPI Number | 1780246090
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Entity Type | Individual
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Provider Name | NANCY GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 5702 FRIENDSHIP RD
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City | TOLAR
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State | TX
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Zip | 76476-5390
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Country | US
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Telephone | 214-734-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 E HWY 377 STE 110-177
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City | GRANBURY
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State | TX
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Zip | 76048-1456
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 211844
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License Number State | TX
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