Provider Demographics
NPI:1407169188
Name:GOMEZ, GABRIEL ELIAS (OTR, ATP)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:ELIAS
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 STRATFORD PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4670
Mailing Address - Country:US
Mailing Address - Phone:281-935-1140
Mailing Address - Fax:
Practice Address - Street 1:3506 STRATFORD PLAZA LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4670
Practice Address - Country:US
Practice Address - Phone:281-935-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111029225XP0019X, 225X00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist