Provider Demographics
NPI:1952866188
Name:GAY, MAYCRYSTAL (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MAYCRYSTAL
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 LOMA HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3707
Mailing Address - Country:US
Mailing Address - Phone:307-399-8531
Mailing Address - Fax:
Practice Address - Street 1:1445 BESSEMER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5930
Practice Address - Country:US
Practice Address - Phone:915-633-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215362224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty