Provider Demographics
NPI:1619488020
Name:HANNON, GAYLE H (COTA)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:H
Last Name:HANNON
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 1:119 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1441
Mailing Address - Country:US
Mailing Address - Phone:864-430-8115
Mailing Address - Fax:
Practice Address - Street 1:11 E AUGUSTA PL APT 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1760
Practice Address - Country:US
Practice Address - Phone:864-991-8378
Practice Address - Fax:864-991-8379
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3406224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant