Provider Demographics
NPI:1760566004
Name:THURMAN, GINA MISITANO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MISITANO
Last Name:THURMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MISITANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:1205 JOHNSON FERRY RD
Practice Address - Street 2:STE 130
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5418
Practice Address - Country:US
Practice Address - Phone:770-565-3201
Practice Address - Fax:770-565-3203
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12415225X00000X
GAOT003903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT0039036OtherOCCUPATIONAL THERAPIST