Provider Demographics
NPI:1215190103
Name:SCHUTRUM, GAYLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:SCHUTRUM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 BEAVER LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2909
Mailing Address - Country:US
Mailing Address - Phone:716-773-6014
Mailing Address - Fax:
Practice Address - Street 1:42 BEAVER LN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2909
Practice Address - Country:US
Practice Address - Phone:716-773-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003793-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist