MEDICARE: AISHA YADEL GONZALEZ OTR/L

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	OT 10378	FL
2	225X00000X	Occupational Therapist	0119004183	VA
3	225X00000X	Occupational Therapist	17-02356	KS

General Provider Information

NPI Number	:	1881791176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHA YADEL GONZALEZ OTR/L

Provider Business Mailing Address
First Line	:	113 GREEN ACRES ST
Second Line	:
City	:	WHITE CITY
State	:	KS
Zip	:	66872-9208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 SOUTH WASHINGTON STREET
Second Line	:	GEARY REHAB & FITNESS
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441
Country	:	US
Telephone Number	:	785-238-3747
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/08/2016

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