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General NPI Number Information
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NPI Number | 1023778644
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Entity Type | Individual
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Provider Name | GAELYN R GINGERY
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Gender | Female
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 1300 W SILVER SPRING DR
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City | GLENDALE
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State | WI
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Zip | 53209-4415
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Country | US
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Telephone | 414-228-8120
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Fax |
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Provider Business Mailing Address
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Address Line | 2130A N 62ND ST
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City | WAUWATOSA
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State | WI
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Zip | 53213-2053
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Country | US
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Telephone | 773-742-4804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 580727
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License Number State | WI
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