Provider Demographics
NPI:1609163518
Name:GONZALEZ, MENDITH (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:MENDITH
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ESTANCIAS DE YAUCO
Mailing Address - Street 2:C/ALEJANDRINA K-8
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0998
Mailing Address - Country:US
Mailing Address - Phone:787-299-5978
Mailing Address - Fax:
Practice Address - Street 1:BO. SUSUA BAJA
Practice Address - Street 2:SECTOR GEMINIS, CALLE LOS CASIANO
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR842225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics