Provider Demographics
NPI:1669683389
Name:DEITSCH, GAIL HILSEBERG (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:HILSEBERG
Last Name:DEITSCH
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:53 GERARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3406
Mailing Address - Country:US
Mailing Address - Phone:410-308-1639
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DRIVE
Practice Address - Street 2:SUITE 406
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-362-0114
Practice Address - Fax:866-566-5311
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00550224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant