Individual
ALEX KENNETH GOTTLEABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATP
Contact information
Practice address
1101 W VICKERY BLVD, FORT WORTH, TX 76104-1025
(682) 885-6294
(682) 885-1135
Mailing address
PO BOX 99283, FORT WORTH, TX 76199-1383
(682) 885-6294
(682) 885-1135
Taxonomy
Speciality
Code
Description
License number
State
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
91528
TX
247200000X
Other Technician
Primary
91528
TX
Other
Enumeration date
08/09/2021
Last updated
11/24/2021
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