Provider Demographics
NPI:1023421583
Name:ESPINO, GERARDO IVAN SR (COTA/L)
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:IVAN
Last Name:ESPINO
Suffix:SR
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1213
Mailing Address - Country:US
Mailing Address - Phone:316-462-3636
Mailing Address - Fax:
Practice Address - Street 1:3636 NORTH RIDGE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9402
Practice Address - Country:US
Practice Address - Phone:316-462-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800783224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant