Provider Demographics
NPI:1245457787
Name:BLANK, GAYLE
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:GUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 SWANHILL CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1607
Mailing Address - Country:US
Mailing Address - Phone:443-838-2516
Mailing Address - Fax:
Practice Address - Street 1:116 SWANHILL CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1607
Practice Address - Country:US
Practice Address - Phone:443-838-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist