Provider Demographics
NPI:1114004785
Name:UNDERWOOD, GARY (OTR)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5368 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6108
Mailing Address - Country:US
Mailing Address - Phone:210-349-0096
Mailing Address - Fax:210-349-0097
Practice Address - Street 1:5368 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6108
Practice Address - Country:US
Practice Address - Phone:210-349-0096
Practice Address - Fax:210-349-0097
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109828225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist