Provider Demographics
NPI:1427338631
Name:VLOET, GINA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:VLOET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:CANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13401 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3707
Mailing Address - Country:US
Mailing Address - Phone:602-943-2942
Mailing Address - Fax:602-943-2942
Practice Address - Street 1:32531 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 105-162
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1519
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:480-948-1323
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1542OtherBOARD OF OCCUPATIONAL THERAPY EXAMINERS
1002876OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY