MEDICARE: MS. JOANNA KAY GONZALEZ OTRL

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	5201006718	MI

General Provider Information

NPI Number	:	1992298053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNA KAY GONZALEZ OTRL

Provider Business Mailing Address
First Line	:	3626 OAKVIEW RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-1843
Country	:	US
Telephone Number	:	248-673-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	7277 RICHARDSON RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-1266
Country	:	US
Telephone Number	:	248-360-4598
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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