Provider Demographics
NPI:1154786093
Name:GONZALEZ, ROSALIND (OT)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IA54 CALLE ACACIA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3122
Mailing Address - Country:US
Mailing Address - Phone:787-908-0836
Mailing Address - Fax:787-859-4307
Practice Address - Street 1:CARR 159 # KM13.5
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2903
Practice Address - Country:US
Practice Address - Phone:787-859-5755
Practice Address - Fax:787-859-4307
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist