Provider Demographics
NPI:1366228413
Name:LANGFORD, GENNA GRACE (OTR)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:GRACE
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:GA
Mailing Address - Zip Code:30547-1937
Mailing Address - Country:US
Mailing Address - Phone:706-768-4772
Mailing Address - Fax:
Practice Address - Street 1:142 MORGAN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-1937
Practice Address - Country:US
Practice Address - Phone:706-768-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist