Healthcare Provider Details

I. General information

NPI: 1124253117
Provider Name (Legal Business Name): GINA SHAFRAN WOODARD OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 ROBINWOOD RD
GASTONIA NC
28054-1693
US

IV. Provider business mailing address

2226 PLEASANT DALE DR
CHARLOTTE NC
28214-9154
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-2319
  • Fax:
Mailing address:
  • Phone: 704-701-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5083
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: