Provider Demographics
NPI:1174658587
Name:HOLECEK, GINA GAIL (MPH, OTRL)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:GAIL
Last Name:HOLECEK
Suffix:
Gender:F
Credentials:MPH, OTRL
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:GAIL
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, OTRL
Mailing Address - Street 1:1161 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2901
Mailing Address - Country:US
Mailing Address - Phone:404-321-9303
Mailing Address - Fax:
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-712-0907
Practice Address - Fax:404-712-5974
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002608225X00000X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility