Provider Demographics
NPI:1205110665
Name:GREGORY, GEORGINA LETICIA (OTR/L)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:LETICIA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BENJAMIN DAY DR
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1869
Mailing Address - Country:US
Mailing Address - Phone:760-861-5229
Mailing Address - Fax:
Practice Address - Street 1:50 BENJAMIN DAY DR
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1869
Practice Address - Country:US
Practice Address - Phone:760-861-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist