Provider Demographics
NPI:1508647017
Name:MOTES, GAIL R (CTRS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:R
Last Name:MOTES
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WES MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2719
Mailing Address - Country:US
Mailing Address - Phone:574-238-2809
Mailing Address - Fax:
Practice Address - Street 1:1201 E 9TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4059
Practice Address - Country:US
Practice Address - Phone:903-583-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL43611225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist