Provider Demographics
NPI:1619949070
Name:CANADA, GAIL A (OTR)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:CANADA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:A
Other - Last Name:KEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13701 W JEWELL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4139
Mailing Address - Country:US
Mailing Address - Phone:720-724-0122
Mailing Address - Fax:
Practice Address - Street 1:13701 W JEWELL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4139
Practice Address - Country:US
Practice Address - Phone:720-724-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10321225X00000X
CO0003629225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888712800Medicaid