Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 580727 | WI |
NPI | 1023778644 |
---|---|
Provider Name | Gaelyn R Gingery |
First Address | Wauwatosa, WI 53213-2053 |
Second Address | Glendale, WI 53209-4415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2021 |
Last Update Date | 22/12/2021 |