Provider Demographics
NPI:1477864759
Name:STANGO, GINA KAY (OTR, OTD, MOT, ATP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:KAY
Last Name:STANGO
Suffix:
Gender:F
Credentials:OTR, OTD, MOT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 ANNALISE DR UNIT 155
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-5452
Mailing Address - Country:US
Mailing Address - Phone:512-792-9501
Mailing Address - Fax:512-792-9534
Practice Address - Street 1:8408 ANNALISE DR UNIT 155
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-5452
Practice Address - Country:US
Practice Address - Phone:512-792-9501
Practice Address - Fax:512-792-9534
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88344225CA2500X
TX117519225X00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology SupplierGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist