Provider Demographics
NPI:1881999605
Name:GONZALEZ, MEGHAN JANELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:JANELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4600 E SHEA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6024
Mailing Address - Country:US
Mailing Address - Phone:602-619-6061
Mailing Address - Fax:602-368-8605
Practice Address - Street 1:4600 E SHEA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6024
Practice Address - Country:US
Practice Address - Phone:602-619-6061
Practice Address - Fax:602-368-8605
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4716225X00000X, 225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing