Provider Demographics
NPI:1871351692
Name:TAVAREZ, GINA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MARKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8836 SELBO PEAK PL NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9456
Mailing Address - Country:US
Mailing Address - Phone:412-200-8189
Mailing Address - Fax:
Practice Address - Street 1:1141 BEACH DR E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4937
Practice Address - Country:US
Practice Address - Phone:360-895-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61495787225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist