Provider Demographics
NPI:1427188838
Name:DI GRAZIA, GINA MIA (OTR/L, COMS, CLVT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MIA
Last Name:DI GRAZIA
Suffix:
Gender:F
Credentials:OTR/L, COMS, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 1/2 CHATTANOOGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3438
Mailing Address - Country:US
Mailing Address - Phone:415-846-6266
Mailing Address - Fax:
Practice Address - Street 1:165 1/2 CHATTANOOGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3438
Practice Address - Country:US
Practice Address - Phone:415-846-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AVCREP CERT. 4898225CX0006X
CAOT5361225X00000X
CAOT 5361225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 5361OtherCA BOARD OF OT
5466OtherACVREP
4898OtherACVREP