Provider Demographics
NPI:1396434825
Name:REYES, GABRIEL III (COTA/L)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:REYES
Suffix:III
Gender:M
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 1:216 TENEVA CV
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4207
Mailing Address - Country:US
Mailing Address - Phone:210-954-6498
Mailing Address - Fax:
Practice Address - Street 1:962 CORONADO BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3228
Practice Address - Country:US
Practice Address - Phone:210-490-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216876224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant