Provider Demographics
NPI:1609597442
Name:GONZALEZ, FABIOLA MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:FABIOLA
Middle Name:MARIE
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:URB LOS CAOBOS 2413 CALLE POMARROSA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2717
Mailing Address - Country:US
Mailing Address - Phone:787-901-9210
Mailing Address - Fax:
Practice Address - Street 1:URB LOS CAOBOS 2413 CALLE POMARROSA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2717
Practice Address - Country:US
Practice Address - Phone:787-901-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist