Individual
GWEN E GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3210 W HIGHWAY 22, CORSICANA, TX 75110-2449
(903) 872-4880
Mailing address
6026 NE COUNTY ROAD 191, POWELL, TX 75153-5418
(903) 467-8675
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215357
TX
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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