Provider Demographics
NPI:1619108016
Name:GONZALES, CHILLIM (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CHILLIM
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:13518 HELEN ST.
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-0003
Mailing Address - Country:US
Mailing Address - Phone:419-769-1114
Mailing Address - Fax:
Practice Address - Street 1:1036 S PERRY ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-2159
Practice Address - Country:US
Practice Address - Phone:419-592-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.03399224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant