Provider Demographics
NPI:1043202153
Name:SANTINY, GINO GIOVANNI (OT)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:GIOVANNI
Last Name:SANTINY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:18641 HIGHWAY 3235
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354-3936
Practice Address - Country:US
Practice Address - Phone:985-475-4555
Practice Address - Fax:985-475-4557
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
766397OtherOPTUM
LA313833YUZ5OtherMEDICARE PTAN
LA313833YWWBOtherMEDICARE PTAN