MEDICARE: SILVIA GONZALEZ OTL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	109451	TX

General Provider Information

NPI Number	:	1235559626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA GONZALEZ OTL

Provider Business Mailing Address
First Line	:	10012 MOUNT RAINIER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2666
Country	:	US
Telephone Number	:	512-372-3777
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 MOUNT RAINIER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2666
Country	:	US
Telephone Number	:	512-372-3777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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