MEDICARE: MRS. PAULA LYNN GONZALES OTR

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	111735	TX

General Provider Information

NPI Number	:	1346322690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA LYNN GONZALES OTR

Provider Business Mailing Address
First Line	:	523 CALM SPGS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4916
Country	:	US
Telephone Number	:	210-488-8217
Fax Number	:	210-277-0740

Provider Business Practice Location Address
First Line	:	523 CALM SPGS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4916
Country	:	US
Telephone Number	:	210-488-8217
Fax Number	:	210-277-0740

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/14/2008

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