Individual
MRS. MARYROSEBEVERLY GONZALES CANCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
24 TALARICO COURT, STATEN ISLAND, NY 10314
(718) 494-6387
(718) 494-6387
Mailing address
24 TALARICO COURT, STATEN ISLAND, NY 10314
(718) 494-6387
(718) 494-6387
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006150
NY
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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