Provider Demographics
NPI:1275992554
Name:GONZALEZ, MONICA (OTA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:RODRIGUEZ
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTA
Mailing Address - Street 1:305 NE LOOP 820 BUSINESS TOWER, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:615A GALE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5955
Practice Address - Country:US
Practice Address - Phone:956-712-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant