Individual
GINA OTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
196 N BELLE MEAD RD STE 3, EAST SETAUKET, NY 11733-3477
(631) 445-9937
Mailing address
16 IMPALA DR, CENTEREACH, NY 11720-1505
(631) 445-9937
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
010973
NY
Other
Enumeration date
01/13/2020
Last updated
01/16/2020
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