Provider Demographics
NPI:1487271714
Name:GONZALES, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416D CHARLESTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1012
Mailing Address - Country:US
Mailing Address - Phone:512-294-4046
Mailing Address - Fax:
Practice Address - Street 1:2416 CHARLESTON ST # D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1012
Practice Address - Country:US
Practice Address - Phone:512-294-4046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX122696225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant