Provider Demographics
NPI:1386669794
Name:FAIRCHILD, GARY P (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:P
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 DEEPWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2901
Mailing Address - Country:US
Mailing Address - Phone:361-664-9675
Mailing Address - Fax:361-664-1100
Practice Address - Street 1:5026 DEEPWOOD CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2901
Practice Address - Country:US
Practice Address - Phone:361-664-9675
Practice Address - Fax:361-664-1100
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3278OtherBLUE CROSS BLUE SHIELD
TX8D3029Medicare ID - Type UnspecifiedIND MEDICARE PROVIDER NUM