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General NPI Number Information
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NPI Number | 1861253296
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Entity Type | Individual
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Provider Name | SHANNEN D GONZALES MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1800 OLD PECOS TRL STE 1
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City | SANTA FE
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State | NM
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Zip | 87505-4759
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Country | US
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Telephone | 505-424-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 OLD PECOS TRL STE 1
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City | SANTA FE
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State | NM
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Zip | 87505-4759
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Country | US
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Telephone | 505-424-8777
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2023-0155
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License Number State | NM
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