Healthcare Provider Details

I. General information

NPI: 1407905664
Provider Name (Legal Business Name): GINA M SIAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OMAHA AVE
CLOVIS CA
93619-7616
US

IV. Provider business mailing address

132 OMAHA AVE
CLOVIS CA
93619-7616
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-0508
  • Fax:
Mailing address:
  • Phone: 559-298-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT2797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: