Provider Demographics
NPI:1851443386
Name:GONZALEZ, JENNIFER JOY (MS, OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DECK RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-9311
Mailing Address - Country:US
Mailing Address - Phone:512-917-6988
Mailing Address - Fax:512-869-8179
Practice Address - Street 1:104 DECK RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-9311
Practice Address - Country:US
Practice Address - Phone:512-917-6988
Practice Address - Fax:512-869-8179
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109282225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics