Provider Demographics
NPI:1598286601
Name:DANTIN, GINA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ELIZABETH
Last Name:DANTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:ELIZABETH
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 ASHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3822
Mailing Address - Country:US
Mailing Address - Phone:847-927-4462
Mailing Address - Fax:
Practice Address - Street 1:564 ASHLAWN DR
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3822
Practice Address - Country:US
Practice Address - Phone:847-927-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist