Provider Demographics
NPI:1326211798
Name:REDMON, GAYLE LYNN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:LYNN
Last Name:REDMON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 W LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2024
Mailing Address - Country:US
Mailing Address - Phone:602-463-9154
Mailing Address - Fax:
Practice Address - Street 1:4740 W LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2024
Practice Address - Country:US
Practice Address - Phone:602-463-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant