Provider Demographics
NPI:1033529888
Name:SHAFER, GAIL ANN (PHD, OTR, CHT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:SHAFER
Suffix:
Gender:F
Credentials:PHD, OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 MERRITT RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:517-322-3232
Mailing Address - Fax:
Practice Address - Street 1:4052 LEGACY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4285
Practice Address - Country:US
Practice Address - Phone:517-394-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000081225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201000081OtherSTATE LICENSE