Provider Demographics
NPI:1346322690
Name:GONZALES, PAULA LYNN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:LYNN
Last Name:GONZALES
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 1:523 CALM SPGS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4916
Mailing Address - Country:US
Mailing Address - Phone:210-488-8217
Mailing Address - Fax:210-277-0740
Practice Address - Street 1:523 CALM SPGS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-4916
Practice Address - Country:US
Practice Address - Phone:210-488-8217
Practice Address - Fax:210-277-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist