Provider Demographics
NPI:1831117670
Name:GONZALEZ, CHRISTY LEAH (LOTR)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEAH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LONE OAK ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3928
Mailing Address - Country:US
Mailing Address - Phone:318-355-7902
Mailing Address - Fax:
Practice Address - Street 1:113 LONE OAK ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-3928
Practice Address - Country:US
Practice Address - Phone:318-355-7902
Practice Address - Fax:318-355-7902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT200002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist