Provider Demographics
NPI:1003935297
Name:GONZALEZ, DEANNA MARIA (OTR)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 MISTY CIR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-7812
Mailing Address - Country:US
Mailing Address - Phone:512-773-3877
Mailing Address - Fax:
Practice Address - Street 1:DARNALL ARMY MEDICAL CENTER
Practice Address - Street 2:OCCUPATIONAL THERAPY DEPARTMENT
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5063
Practice Address - Country:US
Practice Address - Phone:254-288-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist