Healthcare Provider Details

I. General information

NPI: 1427338631
Provider Name (Legal Business Name): GINA MARIE VLOET OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA MARIE CANO OTR/L

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32531 N SCOTTSDALE RD SUITE 105-162
SCOTTSDALE AZ
85266-1519
US

IV. Provider business mailing address

13401 N 58TH ST
SCOTTSDALE AZ
85254-3707
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-3946
  • Fax: 480-948-1323
Mailing address:
  • Phone: 602-943-2942
  • Fax: 602-943-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1542
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: