Provider Demographics
NPI:1821333865
Name:LEMENSE, GINA R (OT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:LEMENSE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:FLORIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-250-1485
Mailing Address - Fax:608-250-1456
Practice Address - Street 1:1806 W BELTLINE HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2334
Practice Address - Country:US
Practice Address - Phone:608-250-1485
Practice Address - Fax:608-250-1456
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5153-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61384OtherDEAN HEALTH INSURANCE