Provider Demographics
NPI:1245447614
Name:GAYLE, EILEEN (BS)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:GAYLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 4TH ST # 224
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4726
Mailing Address - Country:US
Mailing Address - Phone:707-280-5901
Mailing Address - Fax:978-349-6686
Practice Address - Street 1:2751 4TH ST # 224
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4726
Practice Address - Country:US
Practice Address - Phone:707-280-5901
Practice Address - Fax:978-349-6686
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist