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NPI Code Detail

MEDICARE: MISS MARISSA EMILY GONZALEZ OTR/L

MEDICARE: MISS MARISSA EMILY 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
1225XP0019XPhysical Rehabilitation Occupational Therapist11795MA

General Provider Information

NPI Number : 1972033033
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARISSA EMILY GONZALEZ OTR/L
Provider Business Mailing Address
First Line : 19 CUMNER AVE
Second Line :
City : MELROSE
State : MA
Zip : 02176-5016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 ORIENT AVE
Second Line :
City : EAST BOSTON
State : MA
Zip : 02128-1006
Country : US
Telephone Number : 617-569-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2017
Last Update Date : 06/12/2017

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Directions to “ MISS MARISSA EMILY GONZALEZ OTR/L” Practice Location

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