Healthcare Provider Details

I. General information

NPI: 1477864759
Provider Name (Legal Business Name): GINA KAY STANGO OTR, OTD, MOT, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/20/2024
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8408 ANNALISE DR UNIT 155
AUSTIN TX
78744-5452
US

IV. Provider business mailing address

8408 ANNALISE DR UNIT 155
AUSTIN TX
78744-5452
US

V. Phone/Fax

Practice location:
  • Phone: 512-792-9501
  • Fax: 512-792-9534
Mailing address:
  • Phone: 512-792-9501
  • Fax: 512-792-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number88344
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number117519
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: