Provider Demographics
NPI:1477864759
Name:STANGO, GINA KAY (OTR, MOT, ATP, OTDS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KAY
Last Name:STANGO
Suffix:
Gender:F
Credentials:OTR, MOT, ATP, OTDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 REESE DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2612
Mailing Address - Country:US
Mailing Address - Phone:504-258-1311
Mailing Address - Fax:
Practice Address - Street 1:13 REESE DR
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:504-258-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88344225CA2500X
TX117519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology SupplierGroup - Single Specialty