Provider Demographics
NPI:1952052805
Name:GONZALES, MORGAN RAQUEL
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RAQUEL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N HAYDEN RD APT 2071
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1762
Mailing Address - Country:US
Mailing Address - Phone:505-250-2383
Mailing Address - Fax:
Practice Address - Street 1:2700 N HAYDEN RD APT 2071
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1762
Practice Address - Country:US
Practice Address - Phone:505-250-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047003224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant