Active NPI
Mia L Gonzalez, OTD
- Occupational Therapist
- Auburn, IN
National Provider Identifier
1063183374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31007525A
- Practice address
- 1751 Wesley Rd
Auburn, IN 46706-3647 - Phone
- (260) 925-5494
- NPI assigned
- Sep 26, 2021
- Last updated
- Sep 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31007525A | IN | Primary |
Addresses
Primary practice location
1751 Wesley Rd
Auburn, IN 46706-3647
Mailing address
103 1/2 E High St Apt 3
Hicksville, OH 43526-1181
Phone (201) 248-1578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31007525A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632614400000",
"number": "1063183374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 1/2 E HIGH ST APT 3",
"city": "HICKSVILLE",
"state": "OH",
"postal_code": "435261181",
"telephone_number": "201-248-1578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1751 WESLEY RD",
"city": "AUBURN",
"state": "IN",
"postal_code": "467063647",
"telephone_number": "260-925-5494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "MIA",
"middle_name": "L",
"credential": "OTD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-26",
"last_updated": "2021-09-26",
"certification_date": "2021-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31007525A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.