Provider Demographics
NPI:1942700828
Name:CASELLA, GINA LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:CASELLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LEE
Other - Last Name:CORNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:210 N COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 N COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4419
Practice Address - Country:US
Practice Address - Phone:540-631-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119003531OtherVA BOARD OF MEDICINE