Individual
GINA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3339 BURNT MILL DR, VINELAND, NJ 08360-1613
(609) 675-1699
Mailing address
3339 BURNT MILL DR, VINELAND, NJ 08360-1613
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00502300
NJ
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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