Provider Demographics
NPI:1457400376
Name:ROULSTON, GABRIELA CHAPA (OT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:CHAPA
Last Name:ROULSTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 S M ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1555
Mailing Address - Country:US
Mailing Address - Phone:956-668-7433
Mailing Address - Fax:956-668-7183
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-225-7247
Practice Address - Fax:956-668-1819
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist