Individual
JEREMY DAVID GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
289 MORNING GLORY DR, LAKE MARY, FL 32746-6100
(407) 416-4867
Mailing address
289 MORNING GLORY DR, LAKE MARY, FL 32746-6100
(407) 416-4867
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 10825
FL
Other
Enumeration date
05/02/2013
Last updated
05/02/2013
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