Individual
MS. SELENA LEA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2611 JONES AVE, PUEBLO, CO 81004-2650
(719) 564-1735
Mailing address
2611 JONES AVE, PUEBLO, CO 81004-2650
(719) 564-1735
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1029143
CO
Other
Enumeration date
08/14/2013
Last updated
08/14/2013
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