Provider Demographics
NPI:1518195726
Name:WILLIAMS, GINA MARIE (COTA)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:KREMKAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:JEWISH HOME AND CARE CENTER:THERAPY DEPARTMENT
Mailing Address - Street 2:1414 N PROSPECT AVE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3018
Mailing Address - Country:US
Mailing Address - Phone:414-277-8854
Mailing Address - Fax:844-284-6963
Practice Address - Street 1:JEWISH HOME AND CARE CENTER:THERAPY DEPARTMENT
Practice Address - Street 2:1414 N PROSPECT AVE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3018
Practice Address - Country:US
Practice Address - Phone:414-277-8854
Practice Address - Fax:844-284-6963
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4671027174400000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No174400000XOther Service ProvidersSpecialist