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General NPI Number Information
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NPI Number | 1033069810
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Entity Type | Individual
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Provider Name | GENA PETERS TSUKASHIMA OTA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 211 ANA DR
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City | FLORENCE
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State | AL
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Zip | 35630-1768
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Country | US
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Telephone | 256-766-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 111 WHEATON CT
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City | FLORENCE
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State | AL
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Zip | 35633-1744
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Country | US
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Telephone | 256-740-1263
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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 | 1202
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License Number State | AL
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