Talia Marie Gonzalez, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT61190256 Issued in WA

Practice address

1240 Ruddell Rd SE
Lacey, WA 98503-5747

Phone

(360) 970-4778

NPI assigned

Mar 15, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Intervention Association

  • Early Intervention Provider Agency
  • Oakland, CA
  • NPI 1609199512
  NPD (past)

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1932602919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 DUNDEE RD NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985024428",
            "telephone_number": "510-333-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 RUDDELL RD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035747",
            "telephone_number": "360-970-4778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2354 Powell St Ste A",
            "address_purpose": "LOCATION",
            "city": "Emeryville",
            "state": "CA",
            "postal_code": "946081738",
            "country_code": "US",
            "telephone_number": "510-652-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "TALIA",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-15",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT61190256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Gomez, LMP
• Rachel Gomez
• Dream Gonzales, ATC
• Giovanni Gonzalez, CNA
• Latrelle Marie Gonzalez
• Camille Goodale, LMT
• Renae Goodell, PTA, LMP
• Amber Lynn Goodman, M.A.
• Madison Goodwin
• Mahesh Gopalaiah, RPH

• Occupational Therapist in Lacey, WA
• Providers in Lacey, WA by specialty
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.

Verify at the official NPI Registry.