Provider Demographics
NPI:1912268053
Name:BLAAUW, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BLAAUW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SHERMAN ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 SHERMAN ST
Practice Address - Street 2:APT. 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2265
Practice Address - Country:US
Practice Address - Phone:269-760-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist