Provider Demographics
NPI:1639290257
Name:EVANS, GAYLE ELAINE (MOT, OTR)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:ELAINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 WATERWALK CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7354
Mailing Address - Country:US
Mailing Address - Phone:281-344-1067
Mailing Address - Fax:
Practice Address - Street 1:7002 RIVERBROOK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6530
Practice Address - Country:US
Practice Address - Phone:281-343-7125
Practice Address - Fax:281-343-7126
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2566OtherBCBS PROVIDER NUMBER