Provider Demographics
NPI:1306217112
Name:GONZALEZ, CHLOE JEANNINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHLOE
Middle Name:JEANNINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 DORNOCH RD
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6003
Mailing Address - Country:US
Mailing Address - Phone:803-606-6922
Mailing Address - Fax:
Practice Address - Street 1:2019 DORNOCH RD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6003
Practice Address - Country:US
Practice Address - Phone:803-606-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13654225X00000X
SC6344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist