Provider Demographics
NPI:1477622645
Name:GAITHER, ADRIENNE TERESE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:TERESE
Last Name:GAITHER
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 1:11230 ROCKY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4144
Mailing Address - Country:US
Mailing Address - Phone:210-218-2127
Mailing Address - Fax:
Practice Address - Street 1:2203 BABCOCK RD.
Practice Address - Street 2:EASTER SEALS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4121OtherBLUE CROSS BLUE SHEILD ID
TX050551331OtherTAX ID