Individual
SHANNEN D GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
1800 OLD PECOS TRL STE 1, SANTA FE, NM 87505-4759
(505) 424-8777
Mailing address
1800 OLD PECOS TRL STE 1, SANTA FE, NM 87505-4759
(505) 424-8777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2023-0155
NM
Other
Enumeration date
01/22/2024
Last updated
06/11/2025
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