Provider Demographics
NPI:1174158497
Name:GONZALES, BRITTANY MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820; TOWER 1
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:2400 EMPIRE CENTRAL STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4342
Practice Address - Country:US
Practice Address - Phone:214-265-0420
Practice Address - Fax:214-265-0737
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120497225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics