Provider Demographics
NPI:1851567242
Name:OLIVER, GINA DENISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:DENISE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 HIGHWAY 187
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:AL
Mailing Address - Zip Code:35571-3722
Mailing Address - Country:US
Mailing Address - Phone:256-332-8355
Mailing Address - Fax:
Practice Address - Street 1:7195 HIGHWAY 187
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:AL
Practice Address - Zip Code:35571-3722
Practice Address - Country:US
Practice Address - Phone:256-332-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2001224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant