Provider Demographics
NPI:1942386594
Name:PLISCOFSKY, GAYLE J (OT)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:J
Last Name:PLISCOFSKY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828
Mailing Address - Country:US
Mailing Address - Phone:518-955-5666
Mailing Address - Fax:
Practice Address - Street 1:214 STATE ROUTE 197
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828
Practice Address - Country:US
Practice Address - Phone:972-983-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005818225X00000X
TX110770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4671OtherBLUE CROSS BLUE SHIELD