Individual
GINA COOK GOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2001 VAN HAVEN DR, STATESVILLE, NC 28625-4342
(704) 883-9700
Mailing address
2001 VAN HAVEN DR, STATESVILLE, NC 28625-4342
(704) 883-9700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2805
NC
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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