Healthcare Provider Details

I. General information

NPI: 1588974166
Provider Name (Legal Business Name): GINA HUTCHINSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60-14 78TH STREET
MIDDLE VILLAGE NY
11379
US

IV. Provider business mailing address

60-14 78TH STREET
MIDDLE VILLAGE NY
11379
US

V. Phone/Fax

Practice location:
  • Phone: 917-881-8123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0107021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: