Provider Demographics
NPI:1417499039
Name:GAY, AVERY (COTA)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 INDEPENDENCE PKWY
Mailing Address - Street 2:APT 706
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-8201
Mailing Address - Country:US
Mailing Address - Phone:616-828-6087
Mailing Address - Fax:
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-547-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant