Provider Demographics
NPI:1790996981
Name:MOTIL, GINA ROSEMARY (COTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ROSEMARY
Last Name:MOTIL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CLARENDON CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-1836
Mailing Address - Country:US
Mailing Address - Phone:615-791-4532
Mailing Address - Fax:
Practice Address - Street 1:200 STRAHL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3556
Practice Address - Country:US
Practice Address - Phone:615-791-1103
Practice Address - Fax:615-791-7541
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000000616224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant