Healthcare Provider Details

I. General information

NPI: 1306871744
Provider Name (Legal Business Name): GINA LYNN ALSTON OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 POST RD
WARWICK RI
02886-7147
US

IV. Provider business mailing address

7 WATSON DR
RICHMOND RI
02832-2818
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-2700
  • Fax: 401-737-8907
Mailing address:
  • Phone: 401-952-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number818
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: