Provider Demographics
NPI:1427221365
Name:MADRID, GINA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:MADRID
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:OUTTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:801 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1513
Mailing Address - Country:US
Mailing Address - Phone:877-407-3422
Mailing Address - Fax:877-407-4329
Practice Address - Street 1:801 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1513
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00616303OtherRAILROAD MEDICARE
DE004002F23Medicare PIN