Sue E Gonzalez Willis, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA002003 Issued in GA

Practice address

1061 Harmon Ave
Fort Stewart, GA 31314-5641

Phone

(912) 348-6376

NPI assigned

Jun 22, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498089600000",
    "number": "1033639901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 FLINT CREEK DR",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313243716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-348-6376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ WILLIS",
        "first_name": "SUE",
        "middle_name": "E",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2017-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA002003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis Glander
• Bruce Alan Gleason, M.D.
• Mona Glenn, RN
• Rafael Eli Gomila Romero, PH.D.
• German Rene Gonzalez Ramos, MD
• Kelly H Gonzalez, LCSW
• Mario Gonzalez
• Thomas Patrick Goodman
• Scott Gordon Goodrich, D.O.
• Michelle Gore, RN

• Occupational Therapy Assistant in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Occupational Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.