Provider Demographics
NPI:1760345284
Name:AVITIA, GINA DANIELLE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:DANIELLE
Last Name:AVITIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2453
Mailing Address - Country:US
Mailing Address - Phone:913-335-0428
Mailing Address - Fax:913-273-2572
Practice Address - Street 1:7300 NALL AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2453
Practice Address - Country:US
Practice Address - Phone:913-335-0428
Practice Address - Fax:913-273-2572
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist