Provider Demographics
NPI:1003396987
Name:GASCOT, MICHELLE LEE (OTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:GASCOT
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2904
Mailing Address - Country:US
Mailing Address - Phone:214-893-4633
Mailing Address - Fax:
Practice Address - Street 1:106 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4104
Practice Address - Country:US
Practice Address - Phone:972-495-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant