Provider Demographics
NPI:1518413954
Name:TUCKER-ROGHI, GINA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:TUCKER-ROGHI
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2821
Mailing Address - Country:US
Mailing Address - Phone:707-539-3328
Mailing Address - Fax:
Practice Address - Street 1:717 MONTCLAIR DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2821
Practice Address - Country:US
Practice Address - Phone:707-539-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5543225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology