Provider Demographics
NPI:1497523351
Name:GUILLIAMS, GINA NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NICOLE
Last Name:GUILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N LINCOLN AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5774
Mailing Address - Country:US
Mailing Address - Phone:425-283-2998
Mailing Address - Fax:
Practice Address - Street 1:541 E GARDEN DR UNIT O
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3150
Practice Address - Country:US
Practice Address - Phone:970-833-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist