Provider Demographics
NPI:1891944278
Name:BROWN, GAIL TIDWELL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:TIDWELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 REGIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3551
Mailing Address - Country:US
Mailing Address - Phone:662-513-7815
Mailing Address - Fax:662-234-1699
Practice Address - Street 1:967 REGIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3551
Practice Address - Country:US
Practice Address - Phone:662-513-7815
Practice Address - Fax:662-234-1699
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist