Provider Demographics
NPI:1629004486
Name:KUBEC, GINA LYNN DIDONATO (OTD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:LYNN DIDONATO
Last Name:KUBEC
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:LYNN
Other - Last Name:DIDONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9498 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2463
Mailing Address - Country:US
Mailing Address - Phone:330-908-3400
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:128W
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OHOT.007154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2558030Medicaid