Provider Demographics
NPI:1184048456
Name:GONZALEZ, NOEL (OTR, MOT)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 MISSOURI AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5111
Mailing Address - Country:US
Mailing Address - Phone:575-523-8080
Mailing Address - Fax:
Practice Address - Street 1:2445 MISSOURI AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5111
Practice Address - Country:US
Practice Address - Phone:575-523-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist