Provider Demographics
NPI:1184854184
Name:ELBERSON, GINGER M (COTA)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:M
Last Name:ELBERSON
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 1:103 QUINTON OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2394
Mailing Address - Country:US
Mailing Address - Phone:540-533-3895
Mailing Address - Fax:
Practice Address - Street 1:103 QUINTON OAKS CIR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2394
Practice Address - Country:US
Practice Address - Phone:540-533-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0POO3509L314000000X
WVC1786224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility