Provider Demographics
NPI:1114068178
Name:HUTZELL, GAYLE L (CDMS)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:HUTZELL
Suffix:
Gender:F
Credentials:CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9750
Mailing Address - Country:US
Mailing Address - Phone:440-466-2214
Mailing Address - Fax:440-466-2216
Practice Address - Street 1:4795 LINDA DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9750
Practice Address - Country:US
Practice Address - Phone:440-466-2214
Practice Address - Fax:440-466-2216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator