Provider Demographics
NPI:1558919639
Name:GAUGLER, JUDITH LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:GAUGLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:DESELICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35755 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1689
Mailing Address - Country:US
Mailing Address - Phone:440-937-6869
Mailing Address - Fax:
Practice Address - Street 1:35755 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1689
Practice Address - Country:US
Practice Address - Phone:440-937-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist