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General NPI Number Information
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NPI Number | 1992298053
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Entity Type | Individual
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Provider Name | JOANNA KAY GONZALEZ OTRL
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 7277 RICHARDSON RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-1266
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Country | US
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Telephone | 248-360-4598
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Fax |
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Provider Business Mailing Address
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Address Line | 3626 OAKVIEW RD
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City | WATERFORD
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State | MI
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Zip | 48329-1843
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Country | US
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Telephone | 248-673-7778
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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 | 5201006718
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License Number State | MI
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