Provider Demographics
NPI:1649068586
Name:GONZALEZ, CONSTANCE (OTR/L)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
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 1:1977 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-1316
Mailing Address - Country:US
Mailing Address - Phone:631-605-1325
Mailing Address - Fax:
Practice Address - Street 1:1977 MAIN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NY
Practice Address - Zip Code:11948-1316
Practice Address - Country:US
Practice Address - Phone:631-605-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist