Basic Information
| Provider Information | |||||||||
| NPI: | 1104291384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | DEMARCO | ||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | DEMARCO | ||||||||
| OtherFirstName: | GINA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 SHAWNEE ROAD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199992030 | ||||||||
| FaxNumber: | 4199910909 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 WATERFORD STREET | ||||||||
| Address2: | |||||||||
| City: | EDINBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147345021 | ||||||||
| FaxNumber: | 8147341433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC010755 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.