Provider Demographics
NPI:1467576306
Name:ENTENMAN, GAIL ELLEN (OTR)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ELLEN
Last Name:ENTENMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1653
Mailing Address - Country:US
Mailing Address - Phone:727-584-7870
Mailing Address - Fax:
Practice Address - Street 1:1619 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1653
Practice Address - Country:US
Practice Address - Phone:727-584-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist