Provider Demographics
NPI:1881791176
Name:GONZALEZ, AISHA YADEL (OTR/L)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:YADEL
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 1:113 GREEN ACRES ST
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66872-9208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 SOUTH WASHINGTON STREET
Practice Address - Street 2:GEARY REHAB & FITNESS
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441
Practice Address - Country:US
Practice Address - Phone:785-238-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10378225X00000X
VA0119004183225X00000X
KS17-02356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist