Provider Demographics
NPI:1467908913
Name:LAY, GINGER (COTA/L)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:LAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 GRADY RD
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1903
Mailing Address - Country:US
Mailing Address - Phone:423-599-2264
Mailing Address - Fax:
Practice Address - Street 1:720 HIGHLAND AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1834
Practice Address - Country:US
Practice Address - Phone:423-599-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2545224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant