Individual
AMANDA NAOMI GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR
Contact information
Practice address
512 VICTORIA LN STE 13, HARLINGEN, TX 78550-3228
(956) 412-6060
(956) 412-6070
Mailing address
512 VICTORIA LN STE 13, HARLINGEN, TX 78550-3228
(956) 412-6060
(956) 412-6070
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
111197
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046NN
BLUE CROSS BLUE SHIELD
TX
01
—
00994Z
MEDICARE PART B
TX
05
—
178709501
—
TX
01
—
676617
MEDICARE PART A
TX
Enumeration date
02/11/2009
Last updated
02/11/2009
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