Provider Demographics
NPI:1023074036
Name:BLOM, GAIL (MA OTR CHT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:BLOM
Suffix:
Gender:F
Credentials:MA OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OHIO DR
Mailing Address - Street 2:STE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-599-9594
Mailing Address - Fax:972-599-9364
Practice Address - Street 1:1101 OHIO DR
Practice Address - Street 2:STE 105
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-599-9594
Practice Address - Fax:972-599-9364
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103249225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4724960001OtherPALMETTO GBA DMERC
TX8T0248OtherBLUE CROSS BLUE SHIELD
TX004930Medicare ID - Type Unspecified
P75007Medicare UPIN
TX8A1930Medicare ID - Type Unspecified